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背景与目的:目前同期放化疗已推荐为不能手术切除食管癌的标准治疗方法。本研究初步总结我科收治的食管癌同期放化疗的治疗结果,分析影响预后的因素。方法:1996年1月1日～2003年12月31日收治的符合条件的患者共132例,化疗在放疗开始时和放疗剂量达40Gy时给予,放疗总剂量60～70Gy。将患者性别、年龄、病程、病变部位、吞咽困难程度、体重、KPS评分、家族史、治疗前血红蛋白水平、X线分型、病理分级、病变长度、T分期、N分期、M分期、放疗方法、放疗技术、放疗剂量、放疗间断时间、治疗后近期疗效、食管穿孔与否、食管出血情况、再治疗方法作为分析因子,用Cox回归对上述分析因子与预后的关系进行单因素和多因素分析。结果:单因素分析显示影响预后的因素为:病程、病变部位、体重下降、M分期、近期疗效、食管穿孔、食管大出血、复发再治疗方法。多因素分析显示影响预后的独立因素为M分期(P=0.0140,OR=2.515)、近期疗效(P<0.0001,OR=2.181)、食管穿孔(P=0.0220,OR=3.266)、再治疗方法(P=0.0260,OR=1.142)。结论:同期放化疗治疗不能手术切除的食管癌,影响预后的主要因素为M分期、近期疗效、食管穿孔、复发转移后再治疗方法。
Background and Objective: At present, concurrent chemoradiotherapy has been recommended as a standard treatment for patients who can not undergo surgical resection of esophageal cancer. This study summarizes the treatment of esophageal cancer treated with concurrent radiotherapy and chemotherapy in our department, and analyzes the factors that affect the prognosis. Methods: A total of 132 eligible patients were enrolled from January 1, 1996 to December 31, 2003. Chemotherapy was given at the start of radiotherapy and at a dose of 40 Gy. The total dose of radiotherapy was 60-70 Gy. Patients’ sex, age, course of disease, lesion location, degree of dysphagia, body weight, KPS score, family history, pretreatment hemoglobin level, X-ray classification, pathological grade, lesion length, T stage, N stage, M stage, , Radiotherapy technique, radiotherapy dose, intermittent radiotherapy time, short-term curative effect after treatment, esophageal perforation or esophageal bleeding and re-treatment were used as analysis factors. Cox regression was used to analyze the relationship between the above factors and prognosis by univariate and multivariate analysis . Results: Univariate analysis showed that the prognostic factors were: course of disease, lesion location, weight loss, M staging, short-term curative effect, esophageal perforation, esophageal hemorrhage and recurrence and re-treatment. Multivariate analysis showed that the independent factors influencing prognosis were M staging (P = 0.0140, OR = 2.515), short-term curative effect (P <0.0001, OR = 2.181), esophageal perforation (P = 0.0220, OR = 3.266) P = 0.0260, OR = 1.142). Conclusions: The main factors affecting the prognosis of esophageal cancer that can not be surgically resected by concurrent chemoradiotherapy are M staging, short-term curative effect, esophageal perforation and recurrence and metastasis.