Analysis of clinical characteristics and dosimetric factors on long-term survival in locally advanced thoracic esophageal squamous cell carcinoma

doi:10.3760/cma.j.cn371439-20210205-00065

Abstract

Abstract:

Objective To explore the effects of clinical characteristics and dosimetric factors on the survival and prognosis of patients with locally advanced thoracic esophageal squamous cell carcinoma after concurrent chemoradiotherapy (CCRT). Methods A total of 158 patients with locally advanced thoracic esophageal squamous cell carcinoma undergoing CCRT in Shandong Cancer Hospital, Anyang Cancer Hospital of Henan Province, Tengzhou Central People's Hospital of Shandong Province and the First Affiliated Hospital of China Medical University from August 2015 to October 2018 were selected as the research subjects. These patients were divided into standard-dose group (50.0-50.4 Gy, n=59) and high-dose group (>50.4 Gy, n=99) according to the radiotherapy dose. The overall survival (OS) and progression-free survival (PFS) of the two groups after treatment were compared. Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. Cox proportional hazard regression model was used to analyze the adverse prognostic factors. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of lung V₃₀ for patient prognosis. Results In 158 patients with locally advanced esophageal squamous cell carcinoma, 19 cases (12.03%) had complete remission after CCRT, 103 cases (65.19%) had partial remission, 27 cases (17.09%) had stable disease, 9 cases (5.70%) had progression disease, and the total effective rate was 77.22%. The median OS of 158 patients was 41 months (95%CI: 25-57 months), and the 1- and 3-year OS rates were 76% and 51%, respectively. The median PFS was 24 months (95%CI: 13-35 months), and the 1- and 3-year PFS rates were 60% and 39%, respectively. The 1- and 3-year OS rates in the standard-dose group were 74% and 56%, and those in the high-dose group were 77% and 49%, with no statistically significant difference (χ²=0.300, P=0.584). The 1- and 3-year PFS rates in the standard-dose group were 62% and 37%, and those in the high-dose group were 59% and 40%, with no statistically significant difference (χ²<0.001, P=0.990). Univariate analysis showed that the length of the lesion, N stage, clinical stage, short-term efficacy of CCRT, planning target volume (PTV) D_max, gross tumor volume (GTV) D_mean, V₅, V₁₀, V₂₀, V₃₀, D_mean of the left, right and bilateral lung were all the prognostic factors for OS and PFS (all P<0.05). Multivariate analysis showed that the length of the lesion (HR=2.226, 95%CI: 1.244-3.985, P=0.007), N stage (HR=2.819, 95%CI: 1.137-6.991, P=0.025), clinical stage (HR=1.897, 95%CI: 1.079-3.334, P=0.026), short-term efficacy of CCRT (HR=1.805, 95%CI: 1.250-2.606, P=0.002), left lung V₁₀ (HR=0.811, 95%CI: 0.668-0.986, P=0.035), left lung V₃₀ (HR=0.617, 95%CI: 0.408-0.933, P=0.022), right lung V₂₀ (HR=2.067, 95%CI: 1.010-4.231, P=0.047), bilateral lung V₁₀ (HR=1.299, 95%CI: 1.016-1.662, P=0.037) and bilateral lung V₃₀ (HR=2.368, 95%CI: 1.142-4.910, P=0.021) were independent prognostic factors affecting OS. N stage (HR=2.433, 95%CI: 1.201-4.931, P=0.014), short-term efficacy of CCRT (HR=2.067, 95%CI: 1.391-3.071, P<0.001) and bilateral lung V₃₀ (HR=0.113, 95%CI: 0.018-0.719, P=0.021) were independent prognostic factors affecting PFS. The ROC curve for predicting OS and PFS showed that the optimal cut-off value of bilateral lung V₃₀ was 9.5%. Conclusion Compared with the standard-dose group, increasing the dose of radiotherapy fails to improve the long-term survival of patients with locally advanced thoracic squamous cell carcinoma. Lesion length, N stage, clinical stage, short-term efficacy of CCRT, left lung V₁₀ and V₃₀, right lung V₂₀ , bilateral lung V₁₀ and V₃₀ are independent prognostic factors for OS in patients with locally advanced thoracic squamous cell carcinoma. N stage, short-term efficacy of CCRT and bilateral lung V₃₀ are independent prognostic factors for PFS. When bilateral lung V₃₀≤9.5%, the patients' OS and PFS will benefit from the treatment.

Key words: Esophageal neoplasms, Neoplasms,squamous cell, Chemoradiotherapy, Prognosis, Dosimetric factors

Li Xiaoqin, Zhang Kaixian, Li Guang, Zheng Anping, Li Baosheng. Analysis of clinical characteristics and dosimetric factors on long-term survival in locally advanced thoracic esophageal squamous cell carcinoma[J]. Journal of International Oncology, 2021, 48(6): 341-349.

Figures/Tables 9

References 15

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影响因素	OS				PFS
影响因素	HR值	95%CI	P值		HR值		95%CI		P值
PTV
D_max	1.056	1.010~1.105	0.013	1.053		1.011~1.097		0.013
D_min	0.987	0.969~1.006	0.179	0.992		0.976~1.009		0.359
D_mean	1.036	0.989~1.085	0.139	1.040		0.997~1.085		0.071
GTV
D_max	1.108	0.987~1.049	0.259	1.013		0.985~1.040		0.369
D_min	1.002	0.983~1.021	0.840	1.006		0.989~1.024		0.480
D_mean	1.053	1.003~1.105	0.038	1.055		1.010~1.103		0.017
脊髓
D_max	1.041	0.989~1.095	0.122	1.026		0.982~1.072		0.258
D₂	1.044	0.991~1.100	0.108	1.022		0.977~1.070		0.347
心脏
V₂₅	1.006	0.995~1.106	0.278	1.004		0.995~1.103		0.394
V₃₀	1.008	0.995~1.021	0.208	1.004		0.994~1.107		0.377
V₄₀	1.018	0.999~1.037	0.057	1.011		0.993~1.028		0.227
V₅₀	1.034	0.997~1.072	0.071	1.019		0.984~1.055		0.296
D_mean	1.013	0.993~1.035	0.202	1.008		0.990~1.027		0.396
左肺
V₅	1.019	1.005~1.034	0.007	1.015		1.002~1.028		0.027
V₁₀	1.030	1.011~1.049	0.002	1.027		1.010~1.045		0.002
V₂₀	1.052	1.023~1.081	<0.001	1.040		1.015~1.065		0.002
V₃₀	1.071	1.032~1.111	<0.001	1.055		1.020~1.091		0.002
D_mean	1.124	1.054~1.999	<0.001	1.103		1.040~1.070		0.001
右肺
V₅	1.018	1.004~1.032	0.009	1.016		1.004~1.029		0.012
V₁₀	1.027	1.009~1.045	0.002	1.026		1.009~1.043		0.002
V₂₀	1.046	1.015~1.078	0.004	1.040		1.010~1.070		0.009
V₃₀	1.082	1.031~1.135	0.001	1.064		1.016~1.114		0.008
D_mean	1.121	1.043~1.205	0.002	1.109		1.035~1.188		0.003
双肺
V₅	1.020	1.006~1.035	0.006	1.107		1.004~1.030		0.012
V₁₀	1.033	1.013~1.053	0.001	1.032		1.013~1.051		0.001
V₂₀	1.060	1.026~1.095	<0.001	1.049		1.018~1.030		0.002
V₃₀	1.102	1.050~1.155	<0.001	1.080		1.033~1.129		0.001
D_mean	1.143	1.061~1.232	<0.001	1.123		1.047~1.204		0.001

临床分期	例数	标准剂量组(n=59)		高剂量组(n=99)		χ²值	P值
临床分期	例数	1年OS率	3年OS率	1年OS率	3年OS率	χ²值	P值
Ⅱ	35	92	92	90	59	2.630	0.105
Ⅲ	85	73	46	80	49	0.282	0.595
Ⅳa	38	62	46	61	38	0.109	0.741

临床分期	例数	标准剂量组(n=59)		高剂量组(n=99)		χ²值	P值
临床分期	例数	1年PFS率	3年PFS率	1年PFS率	3年PFS率	χ²值	P值
Ⅱ	35	92	62	77	39	1.036	0.309
Ⅲ	85	58	26	55	40	0.225	0.635
Ⅳa	38	46	38	50	32	0.003	0.960

影响因素	OS				PFS
影响因素	HR值	95%CI	P值		HR值		95%CI		P值
病变长度	2.226	1.244~3.985	0.007	1.518		0.919~2.506		0.103
N分期	2.819	1.137~6.991	0.025	2.433		1.201~4.931		0.014
临床分期	1.897	1.079~3.334	0.026	1.290		0.762~2.185		0.344
同步放化疗近期疗效	1.805	1.250~2.606	0.002	2.067		1.391~3.071		<0.001
PTV D_max	1.036	0.920~1.167	0.556	1.000		0.888~1.125		0.995
GTV D_mean	1.011	0.892~1.146	0.862	1.039		0.921~1.172		0.536
左肺
V₅	0.915	0.676~1.239	0.567	1.000		0.779~1.284		1.000
V₁₀	0.811	0.668~0.986	0.035	0.94		0.791~1.118		0.486
V₂₀	1.805	1.038~3.137	0.060	1.093		0.716~1.669		0.679
V₃₀	0.617	0.408~0.933	0.022	0.791		0.551~1.135		0.204
D_mean	2.410	0.501~11.589	0.272	2.727		0.963~7.721		0.059
右肺
V₅	0.927	0.665~1.292	0.656	1.037		0.785~1.371		0.797
V₁₀	1.010	0.933~1.093	0.813	1.025		0.952~1.104		0.513
V₂₀	2.067	1.010~4.231	0.047	1.141		0.650~2.002		0.647
V₃₀	0.888	0.614~1.283	0.527	0.859		0.634~1.166		0.330
D_mean	0.417	0.066~2.651	0.354	1.382		0.348~5.496		0.646
双肺
V₅	1.323	0.707~2.472	0.380	1.011		0.607~1.683		0.967
V₁₀	1.299	1.016~1.662	0.037	1.143		0.914~1.428		0.241
V₂₀	0.325	0.097~1.091	0.069	0.865		0.339~2.206		0.761
V₃₀	2.368	1.142~4.910	0.021	0.113		0.018~0.719		0.021
D_mean	0.254	0.014~4.574	0.353	1.785		0.961~3.316		0.067