摘要
目的探究局部放疗联合化疗或免疫治疗寡转移性食管鳞癌(ESCC)患者的预后及其影响因素。方法回顾性分析2018-03-01-2022-10-31就诊于南京医科大学附属肿瘤医院的转移性ESCC患者,共纳入96例新发寡转移患者作为研究对象。男78例,女18例;年龄47~85岁,中位年龄65岁;在食管肿瘤病灶无进展的情况下,所有患者均接受了局部放疗联合化疗或免疫治疗。96例患者共有106处寡转移病灶,其中64例患者出现器官转移,42例患者发生非区域淋巴结转移,有20例患者既出现器官转移也有非区域淋巴结转移。59例(61.5%)接受图像引导放射治疗(IGRT),37例(38.5%)接受立体定向放射治疗(SBRT)。评估局部控制率(LCR)、无进展生存期(PFS)和总生存期(OS),以及与PFS和OS相关的预后因素。结果中位随访时间为31.1(18.2~44.0)个月。1和2年LCR分别为94.3%和86.8%。中位PFS是21.1(95%CI为15.3~27.0)个月。1和2年的PFS率分别为65.0%和43.4%。中位OS为26.9(95%CI为20.0~33.9)个月。1和2年的OS率分别为80.4%和56.1%。单因素分析中ECOG评分和病灶长径是OS的影响因素,多因素结果显示ECOG评分、病灶长径、放疗方式和转移位置是OS的独立预后因素,均P<0.05。最常见的不良反应是化疗引起的白细胞降低,无治疗相关的死亡病例。结论局部放疗联合全身治疗寡转移ESCC是一种安全且有效的治疗方案。建议临床中将寡转移与多发转移ESCC患者进行分层治疗。
Objective To investigate the prognosis of patients with oligometastatic esophageal squamous carcinoma(ESCC)treated with local radiotherapy combined with chemotherapy or immunotherapy and the factors affecting the prognosis.Methods We retrospectively selected patients with oligometastatic ESCC who visited Nanjing Medical University Cancer Hospital from March 2018 to October 2022.96 patients with new oligometastases from esophageal tumors were included.In the absence of progression of esophageal tumor lesions,all patients received local radiation therapy combined with chemotherapy or immunotherapy.There were 106 oligometastatic lesions in 96 patients,including 64 organ metastases,42 non-regional lymph node metastases,and 20 with both organ and non-regional lymph node metastases.Totally 59 patients(61.5%)received image-guided radiation therapy(IGRT)and 37 patients(38.5%)received stereotactic ablative radiation therapy(SBRT).Local control rate(LCR),progression-free survival(PFS)and overall survival rate(OS),as well as prognostic factors associated with PFS and OS were assessed.Results The median follow-up time was 31.1 months(18.2-44.0).The 1-year and 2-year LCR were respectively 94.3%and 86.8%.The median PFS was 21.1 months(95%CI:15.3-27.0).The 1-year and 2-year PFS rates were 65.0%and 43.4%,respectively.The median OS was 26.9 months(95%CI:20.0-33.9).The1-year and 2-year OS rates were respectively 80.4%and 56.1%.Univariate analysis showed that ECOG score was influential factors for OS.Multivariate results showed that ECOG score,lesion length,radiotherapy modality and metastatic location were independent prognostic factors for OS.The most common adverse effects(AEs)was chemotherapy-induced leukopenia,and there were no treatment-related deaths.Conclusions Local radiotherapy combined with systemic treatment of oligometastatic ESCC is a safe and effective treatment option.Clinical stratification of patients with oligometastatic versus polymetastatic ESCC is recommended.
作者
王天
顾大勇
刘雅恬
周国仁
何侠
叶劲军
WANG Tian;GU Dayong;LIU Yatian;ZHOU Guoren;HE Xia;YE Jinjun(First Clinical College of Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Affiliated Cancer Hospital of Nanjing Medical University/Jiangsu Cancer Hospital/Jiangsu Institute of Cancer Rsearch,Nanjing,Jiangsu 210009,China;不详)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2024年第1期27-32,64,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
吴阶平医学基金会项目(320.6750.19194-60)
江苏省六大人才高峰创新人才团队(TD-SWYY-007)
北京白求恩公益基金会(KY202301-49)。
关键词
食管鳞癌
寡转移
放射治疗
化学治疗
免疫治疗
esophageal squamous cell carcinoma
oligometastatic
radiotherapy
chemotherapy
immunotherapy
