中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2015年
3期
232-236
,共5页
刘施亮%习勉%杨雅迪%赵磊%傅剑华%刘孟忠
劉施亮%習勉%楊雅迪%趙磊%傅劍華%劉孟忠
류시량%습면%양아적%조뢰%부검화%류맹충
食管肿瘤/新辅助放化疗法%临床完全缓解%病理完全缓解%预后
食管腫瘤/新輔助放化療法%臨床完全緩解%病理完全緩解%預後
식관종류/신보조방화요법%림상완전완해%병리완전완해%예후
Esophageal neoplasms/neoadjuvant chemoradiotherapy%Clinical complete response%Pathologic complete response%Prognosis
目的 探讨新辅助放化疗联合手术治疗局部晚期食管鳞癌的临床疗效,并分析临床完全缓解率(cCR)与病理完全缓解率(pCR)的关系.方法 回顾性选取2001-2013年局部晚期胸段食管鳞癌患者158例,全组均采用术前同期放化疗联合手术方式,化疗采用以铂类为基础化疗方案,放疗剂量为40 Gy,2.0 Gy/次,5次/周.Kaplan-Meier法计算OS和DFS,Logrank法检验并单因素预后分析,Cox模型多因素预后分析.结果 全组患者的pCR率为41.1％.新辅助放化疗后44例cCR患者中32例(73％)达pCR,114例非cCR患者中33例(28.9％)达pCR (P =0.000).cCR预测pCR的敏感性、特异性分别为49.2％、87.1％,阳性、阴性预测值分别为72.7％、71.1％.3年总样本数为53例.全组3年OS、DFS分别为53.9％、48.6％,cCR的显著高于非cCR的(P=0.012、P=0.026),pCR的显著高于非pCR的(P =0.000、0.000).多因素分析显示放化疗后病理反应和化疗方案是影响OS的因素.最常见≥3级急性不良反应为白细胞减少(34.2％).结论 新辅助放化疗联合手术治疗局部晚期食管鳞癌可获得较高pCR率且不良反应可耐受,放化疗后cCR率与pCR率、OS密切相关.
目的 探討新輔助放化療聯閤手術治療跼部晚期食管鱗癌的臨床療效,併分析臨床完全緩解率(cCR)與病理完全緩解率(pCR)的關繫.方法 迴顧性選取2001-2013年跼部晚期胸段食管鱗癌患者158例,全組均採用術前同期放化療聯閤手術方式,化療採用以鉑類為基礎化療方案,放療劑量為40 Gy,2.0 Gy/次,5次/週.Kaplan-Meier法計算OS和DFS,Logrank法檢驗併單因素預後分析,Cox模型多因素預後分析.結果 全組患者的pCR率為41.1％.新輔助放化療後44例cCR患者中32例(73％)達pCR,114例非cCR患者中33例(28.9％)達pCR (P =0.000).cCR預測pCR的敏感性、特異性分彆為49.2％、87.1％,暘性、陰性預測值分彆為72.7％、71.1％.3年總樣本數為53例.全組3年OS、DFS分彆為53.9％、48.6％,cCR的顯著高于非cCR的(P=0.012、P=0.026),pCR的顯著高于非pCR的(P =0.000、0.000).多因素分析顯示放化療後病理反應和化療方案是影響OS的因素.最常見≥3級急性不良反應為白細胞減少(34.2％).結論 新輔助放化療聯閤手術治療跼部晚期食管鱗癌可穫得較高pCR率且不良反應可耐受,放化療後cCR率與pCR率、OS密切相關.
목적 탐토신보조방화료연합수술치료국부만기식관린암적림상료효,병분석림상완전완해솔(cCR)여병리완전완해솔(pCR)적관계.방법 회고성선취2001-2013년국부만기흉단식관린암환자158례,전조균채용술전동기방화료연합수술방식,화료채용이박류위기출화료방안,방료제량위40 Gy,2.0 Gy/차,5차/주.Kaplan-Meier법계산OS화DFS,Logrank법검험병단인소예후분석,Cox모형다인소예후분석.결과 전조환자적pCR솔위41.1％.신보조방화료후44례cCR환자중32례(73％)체pCR,114례비cCR환자중33례(28.9％)체pCR (P =0.000).cCR예측pCR적민감성、특이성분별위49.2％、87.1％,양성、음성예측치분별위72.7％、71.1％.3년총양본수위53례.전조3년OS、DFS분별위53.9％、48.6％,cCR적현저고우비cCR적(P=0.012、P=0.026),pCR적현저고우비pCR적(P =0.000、0.000).다인소분석현시방화료후병리반응화화료방안시영향OS적인소.최상견≥3급급성불량반응위백세포감소(34.2％).결론 신보조방화료연합수술치료국부만기식관린암가획득교고pCR솔차불량반응가내수,방화료후cCR솔여pCR솔、OS밀절상관.
Objective To explore the efficacy of neoadjuvant chemoradiotherapy (CRT) followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC),and to investigate the correlation between a clinical complete response (cCR) and a pathologic complete response (pCR).Methods One hundred and fifty-eight patients with locally advanced thoracic ESCC from 2001 to 2013 were retrospectively analyzed.All patients received concurrent chemoradiotherapy followed by surgery.Platinumbased chemotherapy regimens were adopted in chemotherapy and a prescribed dose of 40 Gy in 20 fractions,5 fractions per week,was used in radiotherapy.The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method,and pairwise comparisons and univariate prognostic analyses were performed using the log-rank test.Multivariable prognostic analyses were performed using the Cox regression model.Results The pCR rate was 41.1％ in all patients.After the treatment with neoadjuvant CRT,32(72.7％) out of 44 patients with a cCR had a pCR,but only 33(28.9％) out of 114 patients with a non-cCR had a pCR (P =0.000).The sensitivity,specificity,positive predictive value,and negative predictive value of a cCR in predicting a pCR were 49.2％,87.1％,72.7％,and 71.1％,respectively.The 3-year sample size was 91.The 3-year OS and DFS rates in all patients were 53.9％ and 48.6％,respectively.Patients with a cCR had significantly higher 3-year OS and DFS rates than those with a non-cCR (P =0.012;P =0.026),while patients with a pCR had significantly higher 3-year OS and DFS rates than those with a non-pCR (P =0.000;P =0.000).The multivariate analyses demonstrated that the pathologic response after CRT and chemotherapy regimen were the influencing factors for OS.The most common grade ≥3 acute adverse reaction was leucopenia (34.2％).Conclusions With a high pCR rate and tolerable adverse reactions,neoadjuvant CRT followed by surgery is a safe and effective option for locally advanced ESCC.The cCR rate after CRT is closely correlated with the pCR and OS rates.
