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ENGLISH ABSTRACT
T1～2N0M0期食管癌根治性放疗的预后分析：泛京津冀食管肿瘤多中心协作组多中心回顾性研究(3JECROG R－01H)
路娜
王鑫
李晨
王澜
陈俊强
章文成
王晓敏
葛小林
沈文斌
胡苗苗
袁倩倩
徐勇刚
郝崇礼
周志国
郄帅
肖泽芬
祝淑钗
韩春
乔学英
庞青松
王平
赵一电
孙新臣
张开贤
李苓
李高峰
刘妙玲
王雅棣
作者及单位信息
·
DOI： 10.3760/cma.j.issn.0253-3766.2020.02.010
Prognostic analysis of definitive radiotherapy for early esophageal carcinoma(T1-2N0M0): a multi-center retrospective study of Jing-Jin-ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group
Lu Na
Wang Xin
Li Chen
Wang Lan
Chen Junqiang
Zhang Wencheng
Wang Xiaomin
Ge Xiaolin
Shen Wenbin
Hu Miaomiao
Yuan Qianqian
Xu Yonggang
Hao Chongli
Zhou Zhiguo
Qie Shuai
Xiao Zefen
Zhu Shuchai
Han Chun
Qiao Xueying
Pang Qingsong
Wang Ping
Zhao Yidian
Sun Xinchen
Zhang Kaixian
Li Ling
Li Gaofeng
Liu Miaoling
Wang Yadi
Authors Info & Affiliations
Lu Na
Department of Radiation Oncology, the Seventh Medical Center of PLA General Hospital, Beijing 100700, China
Wang Xin
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li Chen
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Wang Lan
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
Chen Junqiang
Department of Radiation Oncology, Fujian Cancer Hospital/Fujian Medical University Cancer Hospital, Fuzhou 350014, China
Zhang Wencheng
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital/National Clinical Research Center for Cancer, Tianjin 300060, China
Wang Xiaomin
Department 4th of Radiation Oncology, Anyang Cancer Hospital, Anyang 455000, China
Ge Xiaolin
Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Shen Wenbin
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
Hu Miaomiao
Department of Oncology, Tengzhou Central People′s Hospital, Tengzhou 277599, China
Yuan Qianqian
Department of Oncology, Tengzhou Central People′s Hospital, Tengzhou 277599, China
Xu Yonggang
Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Hao Chongli
Department of Oncology, Tengzhou Central People′s Hospital, Tengzhou 277599, China
Zhou Zhiguo
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
Qie Shuai
Department of Radiation Oncology, Affiliated Hospital of Hebei University, Baoding 071000, China
Xiao Zefen
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Zhu Shuchai
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
Han Chun
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
Qiao Xueying
Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
Pang Qingsong
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital/National Clinical Research Center for Cancer, Tianjin 300060, China
Wang Ping
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital/National Clinical Research Center for Cancer, Tianjin 300060, China
Zhao Yidian
Department 4th of Radiation Oncology, Anyang Cancer Hospital, Anyang 455000, China
Sun Xinchen
Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Zhang Kaixian
Department of Oncology, Tengzhou Central People′s Hospital, Tengzhou 277599, China
Li Ling
Department of Oncology, Tengzhou Central People′s Hospital, Tengzhou 277599, China
Li Gaofeng
Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Liu Miaoling
Department of Radiation Oncology, Affiliated Hospital of Hebei University, Baoding 071000, China
Wang Yadi
Department of Radiation Oncology, the Seventh Medical Center of PLA General Hospital, Beijing 100700, China
·
DOI： 10.3760/cma.j.issn.0253-3766.2020.02.010
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摘要

目的探讨T1～2N0M0期食管癌根治性放疗的预后及其影响因素。

方法回顾性分析泛京津冀食管癌协作组10家医疗中心的196例行根治性放疗的T1～2N0M0期食管癌患者的临床资料，其中单纯放疗118例，放疗辅助化疗78例；三维适形放疗(3DCRT)96例，调强放疗(IMRT)100例。计划靶区(PTV)和大体肿瘤区(GTV)中位照射剂量均为60 Gy。中位随访59.2个月。预后影响因素的单因素分析采用Log rank检验，多因素分析采用Cox模型回归分析。

结果全组患者双肺20 Gy剂量照射的体积占总体积的百分比(V 20)为(18.65±7.20)%，平均剂量为(10.81±42.05)Gy。心脏V 30为(14.21±12.28)%，脊髓最高剂量为(39.65±8.13)Gy。放射性肺炎发生率为14.80%(29/196)，放射性食管炎发生率为65.82%(129/196)，均以1～2级为主，无4级以上急性不良反应。全组患者中位总生存时间和无进展生存时间分别为70.1和62.3个月，1、3、5年总生存率分别为86.1%、65.2%和55.8%，1、3、5年无进展生存率分别为75.1%、57.4%和53.2%。多因素Cox模型回归分析显示，患者年龄( HR＝1.023， P＝0.038)、GTV最大横径( HR＝1.243， P＝0.028)是食管癌患者总生存的独立影响因素，GTV体积( HR＝1.718， P＝0.025)是食管癌患者无进展生存的独立影响因素。

结论T1～2N0M0期食管癌患者行根治性放疗疗效较好，患者年龄、GTV最大横径和GTV体积影响放疗预后。

食管肿瘤;放射疗法;三维适形放疗;调强放疗;预后
ABSTRACT

ObjectiveTo evaluate the prognostic factors of T1-2N0M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy.

MethodsThe clinical data of 196 patients with T1-2N0M0 ESCC who were treated with definitive radiotherapy in 10 hospitals were retrospectively analyzed. All sites were members of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG). Radiochemotherapy were applied to 78 patients, while the other 118 patients received radiotherapy only. 96 patients were treated with three-dimensional conformal radiotherapy (3DCRT) and 100 treated with intensity-modulated radiotherapy (IMRT). The median dose of plan target volume(PTV) and gross target volume(GTV) were both 60 Gy. The median follow-up time was 59.2 months. Log rank test and Cox regression analysis were used for univariat and multivariate analysis, respectively.

ResultsThe percentage of normal lung receiving at least 20 Gy (V 20) was (18.65±7.20)%, with average dose of (10.81±42.05) Gy. The percentage of normal heart receiving at least 30 Gy (V 30) was (14.21±12.28)%. The maximum dose of exposure in spinal cord was (39.65±8.13) Gy. The incidence of radiation pneumonia and radiation esophagitis were 14.80%(29/196) and 65.82%(129/196), respectively. The adverse events were mostly grade 1-2, without grade 4 toxicity. Median overall survival (OS) and progression-free survival (PFS) were 70.1 months and 62.3 months, respectively. The 1-, 3- and 5-year OS rates of all patients were 75.1%、57.4% and 53.2%, respectively. The 1-, 3- and 5-year PFS rates were 75.1%、57.4% and 53.2%, respectively. Multivariate analysis demonstrated that patients′age ( HR=1.023, P=0.038) and tumor diameter ( HR=1.243, P=0.028)were the independent prognostic factors for OS, while tumor volume were the independent prognostic factor for PFS.

ConclusionsDefinitive radiotherapy is a promising therapeutic method in patients with T1-2N0M0 ESCC. Patients′ age, tumor diameter and tumor volume may impact patients′ prognosis.

Esophageal neoplasms;Radiotherapy;Three-dimensional conformal radiotherapy;Intensity-modulated radiotherapy;Prognosis
Wang Yadi, Email: mocdef.labiamtohidaygnaw
Han Chun, Email: mocdef.6ab216002nuhcnaH
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引用本文

路娜,王鑫,李晨,等. T1～2N0M0期食管癌根治性放疗的预后分析：泛京津冀食管肿瘤多中心协作组多中心回顾性研究(3JECROG R－01H)[J]. 中华肿瘤杂志,2020,42(02)：139-144.

DOI:10.3760/cma.j.issn.0253-3766.2020.02.010

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一直以来，手术被认为是食管癌的首选治疗手段，尤其是早期患者更是被推荐手术治疗，除非部分患者由于心肺功能欠佳、一般情况差、年龄偏大等原因不能或不愿手术，才考虑接受放疗。以放疗为主的非手术治疗在局部进展期食管癌中疗效已得到肯定，但对早期食管癌，尚无大样本研究报道，多数文献的证据等级较低。在本研究中，我们利用泛京津冀食管肿瘤多中心协作组(Jing－Jin－Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group, 3JECROG)建立的食管癌放疗数据库，开展了多中心回顾性研究(3JECROG R－01H)，旨在探讨基于三维适形放疗(three－dimensional conformal radiotherapy, 3DCRT)和调强放疗(intensity－modulated radiotherapy, IMRT)技术的单纯放疗或同步放化疗治疗T1～2N0M0期食管癌患者的急性不良反应、治疗效果及预后影响因素，为早期食管癌临床治疗方案的选择及后续有关的前瞻性研究提供参考。
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王雅棣，Email: mocdef.labiamtohidaygnaw
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韩春，Email: mocdef.6ab216002nuhcnah
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