肿瘤局部因素与放疗剂量对临床无转移食管鳞癌患者预后的影响

孔雁; 董倩; 李曙光; 许金蕊; 赵小涵; 邓文钊; 沈文斌

doi:10.3971/j.issn.1000-8578.2025.24.0721

肿瘤局部因素与放疗剂量对临床无转移食管鳞癌患者预后的影响

Influence of tumor local factors and radiation dose on prognosis of patients with clinical non-metastatic esophageal squamous cell carcinoma

摘要

摘要: 目的探讨不同放疗剂量对接受根治性放（化）疗的食管鳞癌患者不同肿瘤局部因素的亚组人群预后的影响。方法对符合入组的256例临床无转移食管鳞癌患者进行回顾性分析，首先明确肿瘤局部因素指标预测本组患者预后的最佳截止值，分析近期疗效与肿瘤局部因素相关指标的关系，进行多因素分析，最后进行亚组分析，以进一步确定从不同放疗剂量中获益的亚组人群。结果肿瘤食管病变X线长度、食管病变管壁最大厚度和GTV大小均能预测患者预后。食管病变越短、管壁厚度和GTV越小则患者近期疗效越好（X²=9.066、10.310、15.661，P=0.011、0.006、0.000）。多因素分析结果显示食管GTV、放疗剂量和近期疗效等3项指标为影响患者OS预后的独立性指标（P=0.000、0.038、0.000），后两项指标亦为影响患者PFS预后的独立性指标（P=0.033、0.000）。亚组分析结果显示放疗剂量较大（≥60Gy）时，可使管壁最大厚度≤3.7cm组、食管病变GTV≤37.34 cm³组和未接收同步化疗组患者OS （X²=5.040、4.588、5.400，P=0.025、0.032、0.020）和PFS（X²=6.089、4.353、6.459，P=0.014、0.037、0.011）均获益。结论肿瘤局部因素指标为影响接受根治性放（化）疗食管鳞癌患者的重要预后因素；病变食管壁厚度和肿瘤体积较小的患者可能更能从较高的剂量（≥60Gy）照射中获益。得出相关最终结论需要进一步进行大宗病例的前瞻性、随机对照性研究。

Abstract: Objective To investigate the effect of different radiotherapy doses on the prognosis of subgroups with different tumor local factors in patients with esophageal squamous cell carcinoma who received radical radio(chemo)therapy.Methods A retrospective analysis of 256 patients with non-metastatic esophageal squamous cell carcinoma was performed.First, the optimal cut-off value of tumor local factor indicators to predict the prognosis of this group of patients was determined.The relationship between short-term curative effect and relevant indicators of local tumor factors was analyzed.A multivariate analysis was performed, and finally a subgroup analysis was performed to further identify the subgroups that benefited from different radiation doses.Results The X-ray length of tumor esophageal lesions, the maximum thickness of esophageal lesions and the size of GTV could predict the prognosis of patients.he shorter the esophageal lesion, the smaller the wall thickness and GTV, the better the short-term curative effect of the patients (X²=9.066, 10.310, 15.661, P=0.011, 0.006, 0.000).The results of multivariate analysis showed that esophageal GTV, radiotherapy dose and short-term efficacy were independent indicators affecting the prognosis of patients with OS (P=0.000, 0.038, 0.000), and the latter two indicators were also independent indicators affecting the prognosis of patients with PFS(P=0.033, 0.000).The results of subgroup analysis showed that when the radiation dose was higher(≥60Gy), the maximum thickness of the vessel wall was less than or equal to 3.7cm, the GTV of esophageal lesions was less than or equal to 37.34cm³, and the patients who did not receive concurrent chemotherapy had better OS (X2=5.040, 4.588, 5.400, P=0.025, 0.032, 0.020) and PFS (X2=6.089, 4.353, 6.459, P=0.014, 0.037, 0.011).Conclusion Local tumor factors are important prognostic factors for patients with esophageal squamous cell carcinoma receiving radical radio(chemo)therapy;patients with smaller lesion esophageal wall thickness and tumor volume may be better able to benefit from higher dose (≥60Gy) irradiation.Relevant final conclusions require further prospective, randomized controlled studies with large numbers of cases.

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