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目的 分析食管癌三维适形放疗(3DCRT)的长期疗效及其预后影响因素.方法 回顾分析2001 -2006年首程接受3DCRT的375例食管癌患者的临床资料,其中Ⅰ期9例、Ⅱ期106例、Ⅲ期158例、Ⅳ期102例.观察近期疗效、局部控制率、生存率.采用Kaplan-Meier法计算局部控制率和生存率等,预后影响因素行Logrank法单因素分析和Cox法多因素分析.结果 随访率为94.7％,随访满5年者191例.全组1、3、5年局部控制率分别为80.5％、53.7％、44.9％,生存率分别为67.2％、29.4％、19.0％.单因素预后分析显示疗前进食情况、肿瘤长度、病变横径、T分期、N分期、临床分期、急性放射性食管炎、急性放射性肺炎为影响因素(x2 =46.75、18.52、30.24、42.53、32.71、75.68、7.13、4.64,P=0.000、0.000、0.000、0.000、0.000、0.000、0.008、0.031),多因素预后分析显示肿瘤长度、临床分期、应用化疗、急性放射性食管炎为影响因素(x2 =6.70、18.00、4.87、1.18,P=0.030、0.000、0.027、0.011).结论 食管癌3DCRT后局部控制率有所提高,但长期生存改善并不明显;肿瘤长度、临床分期、应用化疗和急性放射性食管炎为预后影响因素.

Objective To analyze the outcomes and prognostic factors of advanced esophageal carcinoma treated by three-dimensional conformal radiotherapy (3DCRT).Methods From Jul 2001 to Dec 2006.375 patients with esophageal carcinoma treated by 3DCRT were retrospectively analyzed of which Ⅰ stage 9,Ⅱ stage 106,Ⅲ stage 158,Ⅳstage 102.The short-term effect,1-,3-,5-year local regional control rates and survival rates were investigated.The local regional control rates and survival rate were calculated by the Kaplan-Meier method. Univariate prognostic factor was analyzed by Logrank method.Multivariate prognostic factor was analyzed using Cox regression model.Results The follow-up rate was 94.7％.The numbers of patients followed-up with 5 years was 191.The 1-,3-and 5-year local control rates were 80.5％,53.7％,44.9％ respectively.The 1-, 3-and 5-year survival rates were 67.2％,29.4％,19.0％respectively.Univariate analysis showed the significant prognostic factors included the degree of dysphagia,tumor length,the largest diameter of lesion in CT image,T stage,N stage,clinical TNM stage,grades of acute radiation-induced esophagitis and grades of acute radiation-induced pneumonery ( x2 =46.75,18.52,30.24,42.53,32.71,75.68,7.13,4.64,P =0.000,0.000,0.000,0.000,0.000,0.000,0.008,0.031 ).Multivariate analysis revealed tumor length,clinical TNM stage,chemotherapy and grades of acute radiationinduced esophagitis were independent prognostic factors (x2 =6.70,18.00,4.87,1.1 8,P =0.030,0.000,0.027,0.011 ).Conclusions 3DCRT is effective and feasible in treatment of the advanced esophageal carcinoma.Tumor lesion length,clinical TNM stage,chemotherapy and grades of acute radiation-induced esophagitis are independent prognostic factors for survival of patients.