摘要
目的观察老年食管癌患者三维技术放疗的毒副作用和长期疗效，探讨高血压或糖尿病对放射性食管和肺损伤的影响，分析其预后影响因素。方法接受三维技术放疗≥70岁食管鳞癌患者233例，其中伴糖尿病患者27例，高血压63例。分析糖尿病或高血压与放射性食管和肺损伤关系，Kaplan—Meier法计算生存（OS）率，Logrank法行预后单因素分析和Cox法行预后多因素分析。结果糖尿病患者≥3级放射性食管损伤和肺损伤的发生率高于无糖尿病患者（Z=-3．762和-2．972；P〈0．001和0．003）。高血压患者≥3级放射性食管和肺损伤的发生率高于无高血压患者（Z=-2．610和-2．209；P=0．009和0．027）。全组1、3、5年生存（OS）率分别为70．6％、35．8％、23．9％，中位OS为23．0个月（95％CI：18．6～27．5个月）。单因素分析显示，患者年龄（x^2==4．274，P=0．039）、T分期（x^2==9．376，P=0．025）、N分期（x^2=8．504，P=0．014）、TNM分期（x^2=7．806，P=0．020）、肿瘤体积（x^2=5．209，P=0．022）、近期疗效（x^2=25．276，P〈0．001）是影响0S的因素；多因素分析显示，T分期（P=0．001）、N分期（P=0．007）、TNM分期（P=0．002）和近期疗效（P〈0．001）是影响OS的因素。结论老年食管癌患者采用三维技术放疗预后明显提高。糖尿病或高血压为患者发生≥3级放射性食管和肺损伤的易感因素。T分期、N分期、TNM分期和近期疗效是影响预后的独立因素。
Objective To assess the long-term efficacy and adverse effects of three-dimensional radiotherapy （3-DCRT） for elderly patients with esophageal cancer, to investigate the effects of diabetes and hypertension on radiation esophagitis and pneumonitis and to analyze the prognostic factors. Methods A total of 233 patients aged 70 Or over with esophageal squamous cell carcinoma were treated with 3-DCRT, and 27 of the patients had type-2 diabetes and 63 had hypertension. Radiation esophagitis and pneumonitis were monitored in patients with or without diabetes and in patients with or without hypertension. Potential prognostic factors were analyzed by Logrank single factor analysis and Cox multivariate analysis. Results The incidences of radiation esophagitis and pneumonitis in grade 3 or over were significantly higher in patients with diabetes than in those without diabetes （Z = - 3. 762, - 2. 972 ; P = 0. 001,0. 003）. The incidences of radiation esophagitis and pneumonitis in grade 3 or over in patients with hypertension were significantly higher than in those without hypertension （Z=-2. 610, --2. 209;P =0. 009,0. 027）. The 1-,3-and 5-year overall survival （OS） rates were 70.6%, 35.8% and 23.9 %, respectively. The median OS was 23.0 months （95 %CI ：18. 6-27. 5）. Univariate analysis showed that age （X^2 = 4. 274, P --0. 039）, T stage （x^2=9.376,P=0.025）,N-stage （x^2=8.504,P=0.014）,TNM stage （X^2=7.806,P=0.020）, gross tumor volume （GTV） （x^2 = 5. 209, P = 0. 022） and short-term therapeutic efficacy （x^2 = 25. 276,P〈0. 001） had influenced OS. Multivariate analysis showed that T stage （P =0. 001）,N- stage （P=0.007）,TNM stage （P=0.002） and short-term therapeutic efficacy （P〈0.001） were independent prognostic factors for OS. Conclusions 3-DCRT achieves favorable long term efficacy in elderly patients with esophageal cancer. Diabetes and hypertension are potential risk factors for radiation esophagitis and pneumonitis. T-stage, N-stage, TNM stage, and short-
作者
孟庆红
汪建林
丁洁
于静萍
于波
刘惠兰
王坚
Meng Qinghong;Wang Jianlin;Ding Jie;Yu Jingping;Yu Bo;Liu Huilan;Wang Jian(Department of Radiotherapy, the Changzhou Second People＇s Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou 213001 ,China;Department of Radiotherapy, the Jiangyin People＇s Hospital, Jiangyin 214400, China;Department of Tumor, the Taizhou People＇s Hospital, Taizhou 225300, China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2018年第7期793-798,共6页
Chinese Journal of Geriatrics
基金
国家自然科学基金（11705095）
常州市卫生计生委重大科技项目（ZD201710）i常州市高层次卫生人才培养计划（2016C2BJ007）
常州市科技局应用基础研究项目（CJ20159050）
常州市科技计划项目（CE20165024）基金项目：国家自然科学基金（11705095）
常州市卫生计生委重大科技项目（ZD201710）
常州市高层次卫生人才培养计划（2016C2BJ007）
常州市科技局应用基础研究项目（CJ20159050）
常州市科技计划项目（CE20165024）
关键词
食管癌
放射疗法
糖尿病
高血压
Esophageal cancer
Radiotherapy
Diabetes mellitus
Hypertension
