食管鱗癌放化療FP和TP方案的療效比較
發(fā)布時間：2019-06-15 09:41
【摘要】：目的:比較食管鱗癌應用放療聯(lián)合FP(氟尿嘧啶+順鉑)或TP(紫杉醇+順鉑)兩種不同的化療方案的預后及毒副反應的差異,并分析同期放化療后鞏固化療能否使患者獲益。方法:1對2010年1月至2015年12月于河北醫(yī)科大學第四醫(yī)院放五科行根治性放療的744例食管癌患者進行回顧性分析。其中資料完整行放療聯(lián)合FP和TP方案化療的食管鱗癌患者共206例。對行FP和TP方案放化療的206例食管鱗癌患者統(tǒng)計分析,比較兩組的近期療效、總生存期、局控時間及毒副反應等方面的差異。2對其中行同期放化療的123例患者FP組及TP組資料應用傾向評分匹配方法均衡組間協(xié)變量差異,兩組患者按1:1進行匹配后共100例患者匹配成功。觀察匹配后兩組近期療效、生存、局控及毒副反應,分析兩種化療方案的優(yōu)劣、影響生存與局控的預后因素及后續(xù)鞏固化療能否使患者獲益。結果:1全組206例患者中,FP組CR、PR、NR者分別為28.8%(32例)、67.6%(75例)、3.6%(4例);TP組CR、PR、NR者分別為27.4%(26例)、70.5%(67例)、2.1%(2例)。兩組有效率(CR+PR)分別為為96.4%和97.9%,兩組近期療效比較差異無統(tǒng)計學意義(χ2=0.000,P=0.996)。全組1、3、5年生存率分別為76.5%、44.3%、33.2%;1、3、5年局控率分別為69.8%、50.1%、42.2%。FP組與TP組1、3、5年生存率分別為77.3%、45.3%、35.9%和75.5%、40.3%、27.4%(χ2=0.324,P=0.569);1、3、5年局控率分別為66.5%、50.4%、43.9%和73.7%、49.3%、39.9%(χ2=0.011,P=0.915)。毒副反應分析中顯示TP組骨髓抑制的發(fā)生率高于FP組(χ2=20.593,P=0.000),FP組胃腸道反應(χ2=14.122,P=0.007)發(fā)生率高于TP組。其余放化療副反應差異無統(tǒng)計學意義。單因素分析顯示影響局控的為年齡、病變位置、化療方式、近期療效;影響生存的為年齡、病變位置、病變長度、m分期、近期療效。多因素分析結果顯示年齡、病變位置、化療方式是影響局控的獨立預后因素;年齡、病變位置和近期療效是影響總生存期的獨立預后因素。2同期放化療傾向評分匹配后的100例患者中,fp組患者cr、pr和nr者分別為38.0%(19例)、60.0%(30例)和2.0%(1例);tp組患者cr、pr和nr者28.0%(14例)、70.0%(35例)和2.0%(1例),兩組有效率(cr+pr)分別為為98.0%和98.0%,近期療效差異無統(tǒng)計學意義(χ2=0.975,p=0.323)。全組1、3、5年生存率分別為74.9%、42.0%、26.7%;1、3、5年局控率分別為71.4%、49.2%、38.3%。fp組與tp組1、3、5年生存率分別為76.0%、48.7%、30.2%和73.8%、33.7%、22.5%(χ2=1.028,p=0.311);1、3、5年局控率分別為69.3%、50.6%、38.9%和73.5%、47.7%、35.4%(χ2=0.043,p=0.835)。毒副反應分析中顯示tp組骨髓抑制的發(fā)生率高于fp組,有統(tǒng)計學意義(χ2=16.544,p=0.000);其余放化療副反應差異無統(tǒng)計學意義。單因素分析顯示病變位置是影響局控的因素,病變位置、病變長度、m分期、kps評分是影響生存的因素。多因素分析顯示病變位置是影響局控和生存的因素,kps評分是影響生存的因素。行同期放化療的食管鱗癌患者鞏固化療組(55例)與未鞏固化療組(45例)1、3、5年生存率分別為76.0%、39.1%、23.1%和73.3%、45.2%、31.6%(χ2=0.225,p=0.635);1、3、5年局控率分別為71.0%、47.2%、33.6%和71.7%、51.4%、41.5%(χ2=0.040,p=0.842);兩組1、3、5年無遠轉生存率分別為59.9%、32.0%、23.2%和63.7%、43.3%、29.2%(χ2=0.407,p=0.523)。兩組生存、局控、無遠轉生存方面差異無統(tǒng)計學意義。鞏固化療期間3級及以上骨髓抑制發(fā)生率為7.3%,無3級及以上胃腸道反應發(fā)生。行鞏固化療與否的兩組放射性皮膚反應(χ2=0.021,p=0.886)、放射性食管炎(χ2=0.254,p=0.614)及放射性肺炎(χ2=0.151,p=0.698)發(fā)生率差異均無統(tǒng)計學意義。結論:1食管鱗癌患者放化療中fp、tp方案的局控、生存方面相當,tp方案的骨髓抑制發(fā)生率較高,fp方案胃腸道反應發(fā)生率較高,其余毒副反應未見明顯差別。預后分析顯示年長、病變位置靠上、同期放化療的患者有更好的局控,年長、病變位置靠上、近期療效好的患者有更好的生存。2食管鱗癌患者同期放化療中FP、TP方案的局控、生存方面相當,但TP方案的骨髓抑制發(fā)生率高,尤其是4度骨髓抑制,其余毒副反應未見明顯差別。預后分析顯示腫瘤位置靠上者有較好的局控和生存,KPS評分高有更好的生存。3鞏固化療并未使患者在生存、局控、遠轉方面進一步獲益,其毒副反應可耐受。
[Abstract]:Objective: To compare the prognosis of the combination of two different chemotherapy regimens for esophageal squamous cell carcinoma and the difference between the prognosis and the toxicity of the two different chemotherapy regimens, and to analyze whether the chemotherapy can benefit the patients after the concurrent chemoradiotherapy. Methods: A retrospective analysis of 744 patients with esophageal cancer from January 2010 to December 2015 was performed in the fourth hospital of Hebei Medical University. In this study,206 cases of esophageal squamous cell carcinoma with combined FP and TP chemotherapy were reported. A statistical analysis of 206 cases of esophageal squamous cell carcinoma with the radiotherapy and chemotherapy of FP and TP was performed to compare the near-term efficacy and overall survival of the two groups. In the group of 123 patients with concurrent chemoradiotherapy (FP group and TP group), the difference of the group-group covariates was balanced. The results showed that the matching of the two groups was successful in 100 patients after the matching of 1:1. The two groups of short-term curative effect, survival, local control and drug-side reaction after the match were observed, the advantages and disadvantages of the two chemotherapy regimens were analyzed, the prognostic factors of the survival and the local control and the subsequent consolidation of the chemotherapy could benefit the patients. Results: The CR, PR and NR in the group were 28.8% (32 cases), 67.6% (75 cases) and 3.6% (4 cases), respectively. The CR, PR and NR of the group were 27.4% (26 cases), 70.5% (67 cases) and 2.1% (2 cases), respectively. The effective rate (CR + PR) in the two groups was 96.4% and 97.9%, respectively. There was no significant difference between the two groups (2 = 0.000, P = 0.996). The 1,3 and 5-year survival rates of the whole group were 76.5%, 44.3% and 33.2%, respectively. The control rates of the 1,3 and 5 years were 69.8%, 50.1% and 42.2%, respectively. The 1,3 and 5-year survival rates of the group were 77.3%, 45.3%, 35.9% and 75.5%, 40.3%, 27.4% (Sup2 = 0.324, P = 0.569). The control rates of the 1,3 and 5 years were 66.5%, 50.4%, 43.9% and 73.7%, respectively. 49.3%, 39.9% (Sup2 = 0.011, P = 0.915). The incidence of bone marrow suppression in the TP group was higher than that in the FP group (Sup2 = 20.593, P = 0.000), and the incidence of gastrointestinal reaction in the FP group (Sup2 = 14.122, P = 0.007) was higher than that of the TP group. There was no significant difference in the side effects of the other radiotherapy and chemotherapy. The single factor analysis showed that the influence of the local control was the age, the position of the lesion, the mode of chemotherapy, the recent curative effect, the age, the position of the lesion, the length of the lesion, the m stage and the short-term effect. The multi-factor analysis showed that the age, the position of the lesion and the mode of chemotherapy were the independent prognostic factors that affected the local control; the age, the position of the lesion and the short-term effect were the independent prognostic factors that affected the overall survival. R and nr were 38.0% (19 cases), 60.0% (30 cases) and 2.0% (1 case), respectively. The cr, pr and nr in the tp group were 28.0% (14 cases), 70.0% (35 cases) and 2.0% (1 case). The effective rate (cr + pr) in the two groups was 98.0% and 98.0%, respectively. The 1,3 and 5-year survival rates of the whole group were 74.9%, 42.0% and 26.7%, respectively. The control rates of the 1,3 and 5 years were 71.4%, 49.2%, 30.2% and 73.8%, 33.7%, 22.5% (Sup2 = 1.028, p = 0.311), respectively. The control rates of 1,3 and 5 years were 69.3% and 50.6%, respectively. 38.9% and 73.5%, 47.7%, 35.4% (Sup2 = 0.043, p = 0.835). The incidence of bone marrow suppression in the tp group was higher than that of the fp group, and there was no significant difference in the side effects of the remaining chemotherapy and chemotherapy. The single factor analysis shows that the position of the lesion is the factors that affect the local control, the position of the lesion, the length of the lesion, the stage of m, and the kps score are the factors that affect the survival. The multi-factor analysis shows that the position of the lesion is the factor that affects the local control and the survival, and the kps score is the factor that affects the survival. The 1,3 and 5-year survival rates were 76.0%, 39.1%, 23.1% and 73.3%, 45.2%, 31.6% (Sup2 = 0.225, p = 0.635) respectively in the patients with esophageal squamous cell carcinoma treated with radiotherapy and chemotherapy in the same period. The control rates of the 1,3 and 5 years were 71.0%, 47.2%, 33.6% and 71.7%, 51.4%, respectively. 59.9%, 32.0%, 23.2% and 63.7%, 43.3%, 29.2% (Sup2 = 0.407, p = 0.523), respectively. There was no significant difference in the survival, the local control and the non-distant survival of the two groups. The rate of bone marrow suppression at the level 3 and above during the consolidation of chemotherapy was 7.3%, and there was no Grade 3 or higher gastrointestinal reaction. There was no statistical significance between the two groups of radioactive skin reactions (Sup2 = 0.021, p = 0.886), radiation esophagitis (Sup2 = 0.254, p = 0.614) and radiation pneumonitis (Sup2 = 0.151, p = 0.698). Conclusion: In the patients with esophageal squamous cell carcinoma, the ratio of fp and tp in the radiotherapy and chemotherapy of the patients with esophageal squamous cell carcinoma is rather high, the rate of bone marrow suppression in the tp scheme is high, the rate of gastrointestinal reaction in the fp regimen is high, and no significant difference is observed in the other side reactions. The prognosis analysis shows that the elderly and the position of the lesion are on the upper side, the patients with the radiotherapy and chemotherapy in the same period have better local control, the elderly, the position of the pathological changes are on the upper side, and the patients with good curative effect have better survival. However, the incidence of bone marrow suppression in TP regimen was high, especially 4-degree bone marrow suppression, and no significant difference was found in the other side effects. The prognosis analysis showed that the tumor location had better local control and survival, and the KPS score was better for survival. The consolidation of the chemotherapy did not further benefit the patient in the aspects of survival, local control and distant rotation, and its toxic side response was tolerable.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1
[Abstract]:Objective: To compare the prognosis of the combination of two different chemotherapy regimens for esophageal squamous cell carcinoma and the difference between the prognosis and the toxicity of the two different chemotherapy regimens, and to analyze whether the chemotherapy can benefit the patients after the concurrent chemoradiotherapy. Methods: A retrospective analysis of 744 patients with esophageal cancer from January 2010 to December 2015 was performed in the fourth hospital of Hebei Medical University. In this study,206 cases of esophageal squamous cell carcinoma with combined FP and TP chemotherapy were reported. A statistical analysis of 206 cases of esophageal squamous cell carcinoma with the radiotherapy and chemotherapy of FP and TP was performed to compare the near-term efficacy and overall survival of the two groups. In the group of 123 patients with concurrent chemoradiotherapy (FP group and TP group), the difference of the group-group covariates was balanced. The results showed that the matching of the two groups was successful in 100 patients after the matching of 1:1. The two groups of short-term curative effect, survival, local control and drug-side reaction after the match were observed, the advantages and disadvantages of the two chemotherapy regimens were analyzed, the prognostic factors of the survival and the local control and the subsequent consolidation of the chemotherapy could benefit the patients. Results: The CR, PR and NR in the group were 28.8% (32 cases), 67.6% (75 cases) and 3.6% (4 cases), respectively. The CR, PR and NR of the group were 27.4% (26 cases), 70.5% (67 cases) and 2.1% (2 cases), respectively. The effective rate (CR + PR) in the two groups was 96.4% and 97.9%, respectively. There was no significant difference between the two groups (2 = 0.000, P = 0.996). The 1,3 and 5-year survival rates of the whole group were 76.5%, 44.3% and 33.2%, respectively. The control rates of the 1,3 and 5 years were 69.8%, 50.1% and 42.2%, respectively. The 1,3 and 5-year survival rates of the group were 77.3%, 45.3%, 35.9% and 75.5%, 40.3%, 27.4% (Sup2 = 0.324, P = 0.569). The control rates of the 1,3 and 5 years were 66.5%, 50.4%, 43.9% and 73.7%, respectively. 49.3%, 39.9% (Sup2 = 0.011, P = 0.915). The incidence of bone marrow suppression in the TP group was higher than that in the FP group (Sup2 = 20.593, P = 0.000), and the incidence of gastrointestinal reaction in the FP group (Sup2 = 14.122, P = 0.007) was higher than that of the TP group. There was no significant difference in the side effects of the other radiotherapy and chemotherapy. The single factor analysis showed that the influence of the local control was the age, the position of the lesion, the mode of chemotherapy, the recent curative effect, the age, the position of the lesion, the length of the lesion, the m stage and the short-term effect. The multi-factor analysis showed that the age, the position of the lesion and the mode of chemotherapy were the independent prognostic factors that affected the local control; the age, the position of the lesion and the short-term effect were the independent prognostic factors that affected the overall survival. R and nr were 38.0% (19 cases), 60.0% (30 cases) and 2.0% (1 case), respectively. The cr, pr and nr in the tp group were 28.0% (14 cases), 70.0% (35 cases) and 2.0% (1 case). The effective rate (cr + pr) in the two groups was 98.0% and 98.0%, respectively. The 1,3 and 5-year survival rates of the whole group were 74.9%, 42.0% and 26.7%, respectively. The control rates of the 1,3 and 5 years were 71.4%, 49.2%, 30.2% and 73.8%, 33.7%, 22.5% (Sup2 = 1.028, p = 0.311), respectively. The control rates of 1,3 and 5 years were 69.3% and 50.6%, respectively. 38.9% and 73.5%, 47.7%, 35.4% (Sup2 = 0.043, p = 0.835). The incidence of bone marrow suppression in the tp group was higher than that of the fp group, and there was no significant difference in the side effects of the remaining chemotherapy and chemotherapy. The single factor analysis shows that the position of the lesion is the factors that affect the local control, the position of the lesion, the length of the lesion, the stage of m, and the kps score are the factors that affect the survival. The multi-factor analysis shows that the position of the lesion is the factor that affects the local control and the survival, and the kps score is the factor that affects the survival. The 1,3 and 5-year survival rates were 76.0%, 39.1%, 23.1% and 73.3%, 45.2%, 31.6% (Sup2 = 0.225, p = 0.635) respectively in the patients with esophageal squamous cell carcinoma treated with radiotherapy and chemotherapy in the same period. The control rates of the 1,3 and 5 years were 71.0%, 47.2%, 33.6% and 71.7%, 51.4%, respectively. 59.9%, 32.0%, 23.2% and 63.7%, 43.3%, 29.2% (Sup2 = 0.407, p = 0.523), respectively. There was no significant difference in the survival, the local control and the non-distant survival of the two groups. The rate of bone marrow suppression at the level 3 and above during the consolidation of chemotherapy was 7.3%, and there was no Grade 3 or higher gastrointestinal reaction. There was no statistical significance between the two groups of radioactive skin reactions (Sup2 = 0.021, p = 0.886), radiation esophagitis (Sup2 = 0.254, p = 0.614) and radiation pneumonitis (Sup2 = 0.151, p = 0.698). Conclusion: In the patients with esophageal squamous cell carcinoma, the ratio of fp and tp in the radiotherapy and chemotherapy of the patients with esophageal squamous cell carcinoma is rather high, the rate of bone marrow suppression in the tp scheme is high, the rate of gastrointestinal reaction in the fp regimen is high, and no significant difference is observed in the other side reactions. The prognosis analysis shows that the elderly and the position of the lesion are on the upper side, the patients with the radiotherapy and chemotherapy in the same period have better local control, the elderly, the position of the pathological changes are on the upper side, and the patients with good curative effect have better survival. However, the incidence of bone marrow suppression in TP regimen was high, especially 4-degree bone marrow suppression, and no significant difference was found in the other side effects. The prognosis analysis showed that the tumor location had better local control and survival, and the KPS score was better for survival. The consolidation of the chemotherapy did not further benefit the patient in the aspects of survival, local control and distant rotation, and its toxic side response was tolerable.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1
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