TPF方案同步IMRT治疗对中晚期食管癌患者免疫功能及生存预后的影响

摘要/Abstract

摘要：

目的研究多西他赛、顺铂和氟尿嘧啶联合化疗(TPF方案)同步调强放疗(IMRT)对中晚期食管癌患者免疫功能及生存预后的影响。方法筛选2015年6月至2017年12月河北省退役军人总医院收治的中晚期食管癌患者93例,采用随机信封法分为2组,观察组(47例)给予TPF方案同步IMRT,对照组(46例)给予PF方案(顺铂联合氟尿嘧啶)同步IMRT。治疗结束后的1个月内复查食管钡餐、胸部及上腹部CT,评估其近期疗效,并比较两组治疗前后免疫功能情况;绘制Kaplan-Meier生存曲线,以总生存期(OS)评估其远期疗效;收集两组患者不良反应发生情况,评估其安全性。结果治疗后观察组T细胞亚群CD8⁺水平高于对照组[(33.55±4.46)%vs.(29.06±3.61)%,P<0.05],而CD3⁺[(51.29±5.22)%vs.(56.04±6.10)%,P<0.05]、CD4⁺[(28.27±3.63)%vs.(30.35±3.52)%,P<0.05]及CD4⁺/CD8⁺(0.84±0.25vs.1.04±0.08,P<0.05)水平低于对照组。观察组近期治疗有效率达82.98%(39/47),而对照组的有效率仅63.04%(29/46),两组差异具有统计学意义(χ²=4.70,P=0.030)。观察组的中位OS为25.3个月(95%CI为17.9~26.1),对照组为18.2个月(95%CI为14.4~25.5),差异具有统计学意义(χ²=3.28,P=0.038)。两组患者随访期间的不良反应主要为恶心/呕吐、疲乏、食欲不振、血液学毒性、食管炎和肺炎等,大多为1~2级,给予对症处理或结束治疗即可消失;相较于对照组,观察组恶心/呕吐(46.81%vs.78.26%,χ²=9.80,P=0.002)、食欲不振(44.86%vs.71.74%,χ²=6.99,P=0.008)、白细胞减少(36.96%vs.73.91%,χ²=13.37,P<0.001)、食管炎(61.70%vs.82.61%,χ²=5.05,P=0.025)不良反应发生率更低。结论TPF同步IMRT的治疗方案有效性高且不良反应低,可作为中晚期食管癌患者生存预后改善的有效方案。

关键词:食管肿瘤,放射疗法,调强适形,多西他赛,免疫功能,预后

Abstract:

ObjectiveTo study the effects of docetaxel, cisplatin and fluorouracil (TPF) regimen simultaneous intensity modulated radiotherapy (IMRT) on immune function and survival prognosis of patients with advanced esophageal cancer.MethodsA total of 93 patients with advanced esophageal cancer were screened in Hebei Veterans General Hospital from June 2015 to December 2017, and were divided into two groups using randomized envelope method. The observation group (47 cases) was given synchronous TPF regimen and IMRT, and the control group (46 cases) was given synchronous PF regimen (cisplatin combined with fluorouracil) and IMRT. Esophageal barium meal, chest and upper abdominal CT were reviewed within 1 month after treatment to assess the short-term efficacy and compare the immune function of the two groups before and after treatment. Kaplan-Meier survival curve was plotted to evaluate the long-term efficacy based on overall survival (OS). The incidence of adverse reactions in the two groups was collected to evaluate their safety.ResultsAfter treatment, the T cell subgroup CD8⁺level of the observation group was higher than that of the control group [(33.55±4.46)%vs.(29.06±3.61)%,P<0.05], while CD3⁺[(51.29±5.22)%vs.(56.04±6.10)%,P<0.05], CD4⁺[(28.27±3.63)%vs.(30.35±3.52)%,P<0.05] and CD4⁺/CD8⁺(0.84±0.25vs.1.04±0.08,P<0.05) levels were lower than those of the control group. The effective rate of recent treatment in the observation group was 82.98% (39/47), while the effective rate in the control group was only 63.04% (29/46), with a statistically significant difference (χ²=4.70,P=0.030). The median OS of the observation group was 25.3 months (95%CI: 17.9-26.1), and that of the control group was 18.2 months (95%CI: 14.4-25.5), with a statistically significant difference (χ²=3.28,P=0.038). Adverse reactions during the follow-up period of the two groups of patients were mainly nausea/vomiting, fatigue, anorexia, hematological toxicity, esophagitis and pneumonia,etc., which were mostly grade 1-2, and disappeared after symptomatic treatment or termination of treatment. Compared with the control group, the incidence of nausea/vomiting (46.81%vs.78.26%,χ²=9.80,P=0.002), anorexia (44.86%vs.71.74%,χ²=6.99,P=0.008), leukopenia (36.96%vs.73.91%,χ²=13.37,P<0.001) and esophagitis (61.70%vs.82.61%,χ²=5.05,P=0.025) adverse reactions was lower in the observation group.ConclusionTPF combined with IMRT has high efficacy and low adverse reactions, which can be used as an effective treatment to improve the survival prognosis of patients with advanced esophageal cancer.

Key words:Esophageal neoplasms,Radiotherapy,intensity-modulated,Docetaxel,Immune function,Prognosis

耿惠, 胡锋超, 路洪超, 郭军岗, 齐增平. TPF方案同步IMRT治疗对中晚期食管癌患者免疫功能及生存预后的影响[J]. 国际肿瘤学杂志, 2022, 49(2): 84-88.

Geng Hui, Hu Fengchao, Lu Hongchao, Guo Jungang, Qi Zengping. Effects of TPF regimen and IMRT on immune function and survival prognosis of patients with advanced esophageal cancer[J]. Journal of International Oncology, 2022, 49(2): 84-88.

图/表4

表1

两组食管癌患者一般资料比较[ x ?±s/例(%)]"

一般资料	观察组 (n=47)	对照组 (n=46)	t/χ²值	P值
年龄(岁)	49.83±5.36	48.77±5.42	0.99	0.346
性别
男	27(57.45)	20(43.48)	1.82	0.178
女	20(42.55)	26(56.52)
肿瘤部位
胸上及颈段	14(29.79)	11(23.91)
胸中段	19(40.43)	25(54.35)	1.83	0.400
胸下段	14(29.79)	10(21.74)
分化程度
高、中分化	30(63.83)	36(78.26)	2.35	0.125
低、未分化	17(36.17)	10(21.74)
TNM分期
Ⅱ期	15(31.91)	21(45.65)	1.85	0.174
Ⅲ期	32(68.09)	25(54.35)

表1

T细胞亚群	观察组(n=47)		对照组(n=46)
CD3⁺(%)	61.23±6.63	51.29±5.22^a	8.02	<0.001	60.45±6.47	56.04±6.10	3.38	0.001
CD4⁺(%)	33.40±4.18	28.27±3.63^a	6.31	<0.001	32.78±4.01	30.35±3.52	3.10	0.003
CD8⁺(%)	25.36±3.24	33.55±4.46^a	-10.11	<0.001	25.10±3.13	29.06±3.61	-5.66	<0.001
CD4⁺/CD8⁺	1.32±0.30	0.84±0.25^a	8.37	<0.001	1.30±0.31	1.04±0.08	5.56	<0.001

表2

图1

表3

两组食管癌患者不良反应发生情况比较"

不良反应	观察组(n=47)			对照组(n=46)			χ²值	P值
不良反应	1~2级(例)	3~4级(例)	总发生率(%)	1~2级(例)	3~4级(例)	总发生率(%)	χ²值	P值
恶心/呕吐	21	1	46.81	33	3	78.26	9.80	0.002
疲乏	17	0	36.17	19	1	43.48	0.52	0.472
食欲不振	20	1	44.68	31	2	71.74	6.99	0.008
贫血	12	2	29.79	16	4	43.48	1.88	0.170
血小板减少	3	0	6.38	6	0	13.04	0.54	0.462
中性粒细胞减少	16	1	36.17	19	2	45.65	0.87	0.352
白细胞减少	15	2	36.96	27	7	73.91	13.37	<0.001
食管炎	23	6	61.70	35	3	82.61	5.05	0.025
肺炎	11	0	23.40	15	1	34.78	1.46	0.227

表3

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