發(fā)布時(shí)間：2018-06-12 14:00

  本文選題：晚期食管鱗癌 + 吉西他濱�。� 參考：《南昌大學(xué)》2016年碩士論文

【摘要】：目的:回顧性分析在我院接受吉西他濱(GEM)或紫杉醇(PTX)聯(lián)合鉑類化療的共118例晚期食管鱗癌(ESCC)患者的臨床相關(guān)資料,比較不同化療方案療效,并探討影響晚期ESCC的預(yù)后因素。方法:收集2006年1月-2016年3月在我院診治的經(jīng)病理確診的118例初治晚期ESCC患者的臨床相關(guān)資料,其中GEM/鉑類組51例,PTX/鉑類組67例。采用兩獨(dú)立樣本非參數(shù)檢驗(yàn)比較化療近期療效,卡方檢驗(yàn)比較化療毒副反應(yīng),生存率使用壽命表法計(jì)算,遠(yuǎn)期療效及預(yù)后因素分析應(yīng)用Kaplan-Meier法,對(duì)單因素分析有意義的因素,進(jìn)一步行COX比例風(fēng)險(xiǎn)模型多因素分析,探討影響晚期ESCC預(yù)后的獨(dú)立因素。結(jié)果:1、本研究收集患者118例,共行470個(gè)周期化療,患者中位生存時(shí)間(OS)10.8個(gè)月,1.0年、2.0年生存率分別為32.2%、16.9%。GEM組化療205個(gè)周期,完全緩解(CR)5例(9.8%),部分緩解(PR)20例(39.2%),有效率(RR)共25例(49.0%);PTX組共行265個(gè)周期化療,CR 6例(8.9%),PR 24例(35.8%),RR共30例(44.8%);P0.05,GEM組與PTX組近期療無(wú)明顯差異。GEM組中位OS 11個(gè)月,1年、2年生存率分別為33.3%、15.6%;PTX組中位OS 10.4個(gè)月,1年、2年生存率分別為31.3%、17.9%;P0.05,GEM組與PTX組遠(yuǎn)期療效無(wú)明顯差異。GEM組發(fā)生3/4度白細(xì)胞、血小板下降分別為27.4%、25.4%,PTX組分別為:10.4%、7.4%;P0.05,GEM組發(fā)生3/4度白細(xì)胞、血小板下降高于PTX組。GEM組3/4度胃腸道反應(yīng)為19.6%,PTX組為16.4%,P0.05,胃腸反應(yīng)兩組相近。GEM組發(fā)生3度脫發(fā)0例,PTX組3例(4.5%)。兩組不良反應(yīng)均可控制。2、單因素分析顯示:年齡、貧血狀況、轉(zhuǎn)移狀況、化療周期數(shù)、治療方式、疾病進(jìn)展時(shí)間(TTP)為影響晚期ESCC生存預(yù)后的因素。3、多因素分析顯示:貧血狀況、轉(zhuǎn)移狀況、TTP為影響晚期ESCC的獨(dú)立預(yù)后因素。結(jié)論:1、GEM聯(lián)合鉑類、PTX聯(lián)合鉑類在晚期ESCC治療中,近期療效及遠(yuǎn)期療效無(wú)明顯差異,GEM組發(fā)生3/4度白細(xì)胞、血小板下降高于PTX組,PTX組易發(fā)生3度脫發(fā),兩組化療不良反應(yīng)可控制,均可作為晚期ESCC化療的選擇方案。2、年齡、貧血狀況、治療方式、轉(zhuǎn)移狀況、化療周期數(shù)、TTP為影響晚期ESCC生存預(yù)后的因素。3、貧血狀況、轉(zhuǎn)移狀況、TTP為影響晚期ESCC的獨(dú)立預(yù)后因素。
[Abstract]:Objective: to retrospectively analyze the clinical data of 118 patients with advanced esophageal squamous cell carcinoma (ESCC) treated with gemcitabine (GEM) or paclitaxel (PTX) combined with platinum chemotherapy in our hospital, compare the efficacy of different chemotherapy regimens and explore the prognostic factors of advanced ESCC. Methods: clinical data of 118 pathologically diagnosed patients with advanced ESCC in our hospital from January 2006 to March 2016 were collected. Among them, 51 cases were in GEM / platinum group and 67 cases were in PTX / platinum group. Two independent sample nonparametric tests were used to compare the short-term effects of chemotherapy, chi-square test to compare the toxicity of chemotherapy, survival life table method, Kaplan-Meier method to analyze the long-term efficacy and prognostic factors. Multivariate analysis of Cox proportional risk model was carried out to explore the independent factors influencing the prognosis of late ESCC. Results in this study, 118 patients received 470 cycles of chemotherapy. The median survival time of the patients was 10.8 months, 1.0 years, 2.0 years, and the survival rate was 32.20.16.9. the chemotherapy cycles in the gem group were 205 cycles. Total 25 cases of complete remission CRT (CR 6 cases) and PR (PR) 24 cases (35 8RR) there were 30 cases in P0.05GEM group and PTX group in which there was no significant difference in short-term treatment. The survival rate of 1 year and 2 years in gem group was 11 months, 1 year and 2 years survival rate was 1 year and 2 years, the survival rate was not significantly different from that in PTX group (n = 30, P 0.05GEM group) and PTX group (n = 20), there was no significant difference in the short-term treatment between the two groups (P < 0.05), and there was no significant difference between the two groups in the recent treatment. The survival rate was 11 months, 1 year and 2 years in the group of P0.05GEM and PTX respectively. The median OS 10.4 months, 1 year and 2 years survival rates in PTX group were 31.3% and 17.9% respectively. There was no significant difference in long-term effect between GEM group and PTX group. Thrombocytopenia was 27. 4% and 25. 4% respectively in PTX group: 10. 4% and 7. 4 degrees of leukocyte were found in P0. 05 GEM group. The gastrointestinal reaction of 3 / 4 degree in PTX group was higher than that in PTX group. The gastrointestinal reaction in PTX group was 19. 6% and 16. 4% P 0. 05 in PTX group. There were 0 cases of 3 degree alopecia in PTX group and 4. 5% in PTX group. Univariate analysis showed that age, anemia status, metastasis status, chemotherapy cycle number, treatment mode, time of disease progression and TTP were the factors affecting survival and prognosis of advanced ESCC. Multivariate analysis showed that anemia status. TTP was an independent prognostic factor for late ESCC. Conclusion there is no significant difference in the short-term and long-term curative effect in the treatment of advanced ESCC with the combination of neutrophil neutropene gem and platinum-group PTX, and there is no significant difference in the short-term and long-term effects. Thrombocytopenia is more likely to occur in the PTX group than that in the PTX group, and the adverse effects of chemotherapy in the two groups can be controlled. It can be used as the choice of chemotherapy regimen of advanced ESCC, age, anemia, treatment mode, metastasis, TTP as the factors that influence the survival and prognosis of advanced ESCC, anemia and metastasis as independent prognostic factors of late ESCC.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.1

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