不同放疗方案治疗晚期食管鳞状细胞癌的临床价值评析

doi:10.3760/cma.j.cn371439-20200710-00092

摘要/Abstract

摘要：

目的对比不同放疗方案治疗晚期食管鳞状细胞癌的临床疗效、不良反应及预后。方法回顾性分析2015年1月至2020年1月于江苏省如皋市人民医院接受放疗的60例ⅣB期食管鳞状细胞癌患者的临床资料。根据放疗剂量将患者分为标准剂量组(放疗总剂量<50.4 Gy)和高剂量组(放疗总剂量≥50.4 Gy),每组各30例。采用Wilcoxon符号秩和检验分析患者治疗前后吞咽困难评分,采用χ²检验对比两组患者放疗有效率、吞咽困难缓解率及不良反应发生率。采用Kaplan-Meier法进行生存分析,log-rank检验比较组间生存差异。结果标准剂量组和高剂量组患者放疗前及放疗后吞咽困难评分差异均无统计学意义(Z=1.232,P=0.876;Z=1.506,P=0.278)。全组患者放疗后吞咽困难症状得到缓解,吞咽困难评分较放疗前差异有统计学意义(Z=6.347,P<0.001)。标准剂量组和高剂量组患者放疗有效率分别为76.7%(23/30)和83.3%(25/30),差异无统计学意义(χ²=0.417,P=0.519);吞咽困难缓解率分别为80.0%(24/30)和90.0%(27/30),差异无统计学意义(χ²=0.523,P=0.470);不良反应发生率分别为43.3%(13/30)、83.3%(25/30),差异有统计学意义(χ²=10.335,P=0.001)。标准剂量组和高剂量组患者中位总生存期分别为11个月和9个月,差异无统计学意义(χ²=1.490,P=0.256)。结论标准剂量组和高剂量组晚期食管鳞状细胞癌患者在近期疗效、症状缓解及远期预后方面无明显差异,但接受标准剂量放疗的患者不良反应发生率低,值得在临床上应用。

关键词: 食管肿瘤, 肿瘤,鳞状细胞, 肿瘤转移, 放射疗法, 治疗结果

Abstract:

Objective To compare the clinical efficacy, adverse reactions and prognosis of different radiotherapy schemes in the treatment of advanced esophageal squamous cell carcinoma.Methods The clinical data of 60 patients with stage ⅣB esophageal squamous cell carcinoma who received radiotherapy in Rugao People's Hospital of Jiangsu Province from January 2015 to January 2020 were retrospectively analyzed. According to the radiation doses, the patients were divided into standard dose group (total radiation dose <50.4 Gy) and high dose group (total radiation dose ≥50.4 Gy), with 30 patients in each group. The scores of dysphagia before and after treatment were analyzed by Wilcoxon signed-rank test. The radiotherapy effective rate, remission rate of dysphagia and incidence of adverse reactions were analyzed by χ ² test. Survival analysis was carried out by Kaplan-Meier and log-rank test was used to compare the prognosis of the two groups. Results There were no significant differences in dysphagia scores between standard dose group and high dose group before and after radiotherapy (Z=1.232, P=0.876; Z=1.506, P=0.278). The dysphagia symptoms were relieved after radiotherapy in all patients, and the dysphagia score was significantly higher than that before radiotherapy (Z=6.347, P<0.001). The radiotherapy effective rates in the standard dose group and high dose group were 76.7% (23/30) and 83.3% (25/30) respectively, with no statistically significant difference (χ²=0.417, P=0.519). The remission rates of dysphagia in the two groups were 80.0% (24/30) and 90.0% (27/30) respectively, with no statistically significant difference (χ ²=0.523, P=0.470). The incidences of adverse reactions in the two groups were 43.3% (13/30) and 83.3% (25/30) respectively, with a statistically significant difference (χ ²=10.335, P=0.001). The median overall survival in the standard dose group and high dose group were 11 months and 9 months respectively, with no statistically significant difference (χ ²=1.490, P=0.256). Conclusion There are no statistical differences in short-time efficacy, symptom remission and long-term prognosis between the standard dose group and the high dose group in patients with advanced esophageal squamous cell carcinoma. However, the incidence of adverse reactions in patients receiving standard dose radiotherapy is low, which is worthy of clinical application.

Key words: Esophageal neoplasms, Neoplasms,squamous cell, Neoplasm metastasis, Radiotherapy, Treatment outcome

王斌, 周江云, 刘曦. 不同放疗方案治疗晚期食管鳞状细胞癌的临床价值评析[J]. 国际肿瘤学杂志, 2021, 48(8): 484-488.

Wang Bin, Zhou Jiangyun, Liu Xi. Analysis of the clinical value of different radiotherapy schemes in patients with advanced esophageal squamous cell carcinoma[J]. Journal of International Oncology, 2021, 48(8): 484-488.

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项目	高剂量组 (n=30)	标准剂量组 (n=30)	χ²值	P值
年龄(岁)
<70	23(76.7)	26(86.7)	1.002	0.317
≥70	7(23.3)	4(13.3)
性别
男	26(86.7)	26(86.7)	<0.001	>0.999
女	4(13.3)	4(13.3)
KPS评分(分)
<80	7(23.3)	5(16.7)	0.417	0.519
≥80	23(76.7)	25(83.3)
肿瘤直径(cm)
<2	10(33.3)	8(26.7)	0.317	0.573
≥2	20(66.7)	22(73.3)
肿瘤长度(cm)
<5	9(30.0)	16(53.3)	3.360	0.067
≥5	21(70.0)	14(46.7)
同步化疗
有	25(83.3)	28(93.3)	0.647	0.421
无	5(16.7)	2(6.7)

组别	0分	1分	2分	3分	4分
高剂量组(n=30)	0	0	7	20	3
标准剂量组(n=30)	0	0	7	19	4
Z值	1.232
P值	0.876

组别	0分	1分	2分	3分	4分
高剂量组(n=30)	3	8	10	8	1
标准剂量组(n=30)	4	10	12	4	0
Z值	1.506
P值	0.278