基于CT测量的食管肿瘤体积对5-Fu联合顺铂同步放化疗疗效的预测价值

doi:10.12092/j.issn.1009-2501.2018.12.010

中国临床药理学与治疗学 ›› 2018, Vol. 23 ›› Issue (12): 1373-1379.doi: 10.12092/j.issn.1009-2501.2018.12.010

基于CT测量的食管肿瘤体积对5-Fu联合顺铂同步放化疗疗效的预测价值

吕文龙^1,2，陈秀英^1,2，洪金省^1,2，刘锋^1,2，张纬建^1,2

¹福建医科大学附属第一医院放疗科；²福建省肿瘤个体化主动免疫治疗重点实验室，放射生物福建省高等学校重点实验室（福建医科大学），福州 350004，福建

收稿日期:2018-10-11 修回日期:2018-11-08 出版日期:2018-12-26 发布日期:2018-12-27
通讯作者: 张纬建，男，本科，主任医师，硕士生导师，研究方向为肿瘤放射治疗、放射损伤及防护。 Tel：13809511120 E-mail:zwj9090@126.com
作者简介:吕文龙，男，硕士，医师，从事肿瘤临床治疗工作。
基金资助:
福建省自然科学基金项目（2018J101169）

Predictive value of Esophageal tumor volume based on CT measurement for concurrent chemo-radiotherapy with PF program（5-Fu+DDP）

LV Wenlong ^1,2, CHEN Xiuying ^1,2, HONG Jinsheng ^1,2, LIU Feng ^1,2, ZHANG Weijian ^1,2

¹Department of Radiation Oncology, the First Affiliated Hospital of Fujian Medical University; ²Fujian Key Laboratory of Individualized Active Immunotherapy and Key Laboratory of Radiation Biology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, Fujian, China

Received:2018-10-11 Revised:2018-11-08 Online:2018-12-26 Published:2018-12-27

摘要/Abstract

摘要：

目的: 探讨非手术食管癌患者放化疗前原发灶肿瘤体积（GTV）、同步放化疗（5-Fu+DDP方案）后肿瘤体积退缩率（VRR）是否有预测预后的价值。方法: 回顾性分析2010年6月至2013年10月于我科行同步放化疗的非手术食管癌患者77例，分期T2（21例，27.3%）、T3（37例，48%）、T4（19例，24.7%），临床分期II（34例，44.1%）、III期（28例，36.4%）、IV期（15例，19.5%）。根据放疗前、放疗结束时的CT影像，测量病灶长度、GTV及VRR［VRR=（放疗前原发灶肿瘤体积-放疗结束肿瘤体积）/放疗前肿瘤体积］。应用Kaplan-Meier法分析生存率，采用COX风险回归模型分析GTV、VRR、年龄、性别、T分期、临床分期、病变长度、病理类型、照射剂量、吸烟史对非手术食管癌同步放化疗患者生存率的独立预测价值。结果: 随访终止时间2018年9月1日，随访率94.8%（73/77），共73例，死亡64例，中位生存时间15个月，全组患者1年、3年、5年生存率分别为65.8%、24.7%、14.8%。GTV≥25 mL 组：共35例，死亡32例，中位生存时间为10个月，1年、3年、5年生存率分别为42.9%、11.4%、8.6%；GTV＜25 mL组：共38例，死亡32例，中位生存时间为27个月，1年、3年、5年生存率分别为68.4%、36.8%、20.3%；二者差异具有统计学意义（χ ²=9.542，P=0.002）；VRR≥0.3组：共41例，死亡33例，中位生存时间为16个月；1年、3年、5年生存率分别为75.6%、29.3%、19.5%；VRR＜0.3组：共32例，死亡31例，中位生存时间为12个月，1年、3年、5年生存率分别为62.5%、18.8%、7.8%；二者差异不具有统计学意义（χ² =2.419，P=0.120）。Log-Rank法单因素分析显示：GTV≥25(HR=2.136，P=0.003），与患者的预后相关；COX多因素分析显示：VRR（HR=0.309， P=0.001）、GTV (HR=6.557，P=0.000）对生存期有影响，是影响预后的独立因素。结论: 食管癌放化疗前原发灶肿瘤体积及同步放化疗后肿瘤体积退缩率是影响预后的独立因素，建议根据放化疗前的原发灶肿瘤体积及同步放化疗后肿瘤体积退缩率及时调整综合治疗方案。

关键词: 食管癌, 同步放化疗, 原发肿瘤体积, 肿瘤退缩率, 预后

Abstract:

AIM: To analyze the predictive prognostic value of the gross tumor volume (GTV) before chemo-radiotherapy and the tumor volume reduction rate (VRR) after concurrent chemo-radiotherapy (based on PF program) in patients with non-surgical esophageal cancer. METHODS: Clinical data from 77 patients with non-surgical esophageal cancer who under the concurrent chemo-radiotherapy from June 2010 to October 2013 at the First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. Of the 77 patients, 21(27.3%) were at stage T2, 37 (48.0%) at stage T3, and 19 (24.7%) at stageT4; clinical stage II (34, 44.1%), stage III (28, 36.4%), stage IV (15, 19.5%). The tumor length, GTV, and VRR (（pGTV-iGTV）/pGTV) were measured according to CT images before and at the end of chemo-radiotherapy. The Kaplan-Meier method was used to analyze the survival rate. The COX risk regression model was used to analyze the independent predictive value of GTV, VRR, age, gender, T stage, clinical stage, tumor length, pathological type, RT dose and smoking history in the survival rate of non-surgical esophageal cancer who under the concurrent chemo- radiotherapy. RESULTS: The follow-up time ended on September 1st, 2018. The follow-up rate was 94.8% (73/77), of the 73 cases, 64 cases died, and the median survival time was 15 months of the whole group: the 1-year, 3-year and 5-year survival rates were 65.8%, 24.7%,14.8%, respectively; GTV≥25 mL group: of the 35 cases, 32 cases died, the median survival time was 10 months, the 1-year, 3-year and 5-year survival rates were 42.9%,11.4%,8.6%, respectively; GTV<25 mL group: of the 38 cases, 32 deaths. The median survival time was 27 months, and the 1-year, 3-year and 5-year survival rates were 68.4%, 36.8%, 20.3%, respectively; the difference was statistically significant (χ2=9.542, P=0.002); VRR≥0.3 group: of the 41 cases, 33 cases died, the median survival time was 16 months, the 1-year, 3-year and 5-year survival rates were 75.6%, 29.3%,19.5%, respectively. VRR<0.3 group: of the 32 cases, 31 cases died, and the median survival time was 12 months. the 1-year, 3-year and 5-year survival rates were 62.5%,18.8%,7.8%, respectively, and the difference was not statistically significant (χ2=2.419，P=0.120). Univariate analysis by Log-Rank showed: GTV≥25, (HR=2.136, P=0.003), which was related to the prognosis of patients; Multivariate Cox regression analysis showed that VRR（HR=0.309, P=0.001）,GTV (HR=6.557, P=0.000） had an effect on survival and were independent prognostic factors. CONCLUSION: The gross tumor volume (GTV) before chemo-radiotherapy and the tumor volume reduction rate (VRR) are independent factors affecting prognosis. It is recommended to adjust the comprehensive treatment plan according to the GTV and VRR.

Key words: esophageal cancer, concurrent chemo-radiotherapy, gross tumor volume, tumor volume reduction rate, prognosis

中图分类号:

吕文龙，陈秀英，洪金省，刘锋，张纬建. 基于CT测量的食管肿瘤体积对5-Fu联合顺铂同步放化疗疗效的预测价值[J]. 中国临床药理学与治疗学, 2018, 23(12): 1373-1379.

LV Wenlong, CHEN Xiuying, HONG Jinsheng, LIU Feng, ZHANG Weijian. Predictive value of Esophageal tumor volume based on CT measurement for concurrent chemo-radiotherapy with PF program（5-Fu+DDP）[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(12): 1373-1379.

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基于CT测量的食管肿瘤体积对5-Fu联合顺铂同步放化疗疗效的预测价值

Predictive value of Esophageal tumor volume based on CT measurement for concurrent chemo-radiotherapy with PF program（5-Fu+DDP）

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