Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 79
Filter
Add filters








Year range
1.
Article in Chinese | WPRIM | ID: wpr-910522

ABSTRACT

Objective:To investigate the relationship between Onodera′s prognostic nutritional index (PNI) and prognosis of patients with esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy or radiotherapy, aiming to provide a convenient, effective and accurate predictive indicator for evaluating the long-term survival of patients after treatment.Methods:Clinical data of 231 ESCC patients treated with definitive chemoradiotherapy or radiotherapy at the Fourth Hospital of Hebei Medical University from 2013 to 2015 were retrospectively analyzed. The PNI values of each patient at different radiotherapy periods were calculated and the ROC curve was used to determine the optimal cutoff value of PNI before radiotherapy, 231 patients were divided into the better-nourishment group ( n=86) and worse-nourishment group ( n=145). Kaplan- Meier method was used for survival analysis. Cox proportional hazards model was utilized to analyze the relationship between different nutritional status and prognosis. The short-term clinical efficacy and incidence of acute toxicities were statistically compared between two groups. Results:The mean values of PNI before, at week 3, week 6 and 1 month after radiotherapy were48.68±5.08, 39.68±4.87, 43.74±4.89 and48.31±4.92, respectively. The optimal cutoff value of pretreatment PNI was 49.25, the area under the curve (AUC) was 0.655, the sensitivity and specificity were 68.6% and 60.9%, respectively. The 5-year overall survival (OS) and progression-free survival (PFS) rates in the better-nourishment group (PNI≥49.25) were 36.0% and 31.3%, significantly better than 19.3% and 18.6% in the worse-nourishment group (PNI<49.25)( P=0.001, P=0.039). Multivariate analysis showed PNI before the therapy was an independent prognostic factor for OS ( P=0.021). Stratified analysis demonstrated that Stage Ⅰ/Ⅱ and concurrent chemotherapy patients in the better-nourishment group all obtained significantly better OS than their counterparts in the worse-nourishment group ( P=0.007, P=0.004). In addition, the objective response rate in the better-nourishment group was significantly higher than that in the worse-nourishment group ( P=0.047), whereas the incidence of ≥3 grade radiation esophagitis was lower than that in the worse-nourishment group ( P=0.060). Conclusions:Pretreatment PNI is a convenient and reliable indicator for predicting the long-term survival of ESCC patients after definitive chemoradiotherapy or radiotherapy. Patients with higher PNI have relatively better prognosis and radiotherapy tolerance, especially in those with early stage or concurrent chemotherapy.

2.
Article in Chinese | WPRIM | ID: wpr-910506

ABSTRACT

Objective:To explore the benefit groups of patients with locoregional recurrence of esophageal thoracic squamous cell carcinoma who received radiotherapy or chemoradiotherapy with different patterns of irradiation.Methods:Clinical data of 344 esophageal thoracic squamous cell carcinoma patients with postoperative recurrence who received intensity conformal radiotherapy or concurrent chemoradiotherapy in the Fourth Hospital of Hebei Medical University from 2009 to 2014 were retrospectively analyzed. The distribution of recurrence sites and prognostic factors were analyzed. A stratified analysis was carried out on the benefit groups of patients receiving the elective nodal irradiation (ENI) and involved field irradiation (IFI).Results:276 cases (80.2%) recurred at a single site and 68 cases (19.8%) recurred at more than two sites. The follow-up rate was 96.2%. The 1-, 3-and 5-year overall survival rates were 53.6%, 22.6% and 16.4%, respectively, with a median of 12.8 months (95% CI: 11.3-14.3 months). The 1-, 3-and 5-year local recurrence-free survival rates were 46.5%, 16.9% and 12.0%, respectively, with a median of 11.0 months (95% CI: 9.6-12.4 months). The 1-, 3-and 5-year progression-free survival rates were 39.8%, 11.3% and 6.7%, respectively, with a median of 7.9 months (95% CI: 5.8-10.0 months). Multivariate analysis showed that gender, the log odds of metastatic lymph nodes (LODDS) and the number of chemotherapy cycles were the independent prognostic factors ( P=0.003, <0.001, <0.001). Subgroup univariate analysis demonstrated that patients with an esophageal lesion length<5.0 cm, N 0 stage, the number of surgically-dissected lymph nodes of ≤9, the number of postoperative positive lymph node metastasis site of 0, and LODDS≤0.030 obtained benefits from ENI ( P=0.032, 0.012, 0.001, 0.012 and 0.014). Patients with the number of surgically-dissected lymph nodes of ≥16 achieved benefits from IFI ( P=0.035). Conclusions:Radiotherapy is an effective treatment mode for patients with local recurrence after esophageal cancer surgery. For patients with preoperative esophagography showing shorter esophageal lesions, earlier postoperative pathological N stage, lower LODDS score, and fewer surgically-dissected lymph nodes probably obtain more benefits from ENI than IFI. However, patients with more surgically-dissected lymph nodes may obtain more benefit from IFI compared with ENI.

3.
Article in Chinese | WPRIM | ID: wpr-910468

ABSTRACT

Objective:To evaluate the effects of different irradiation doses on postoperative local recurrence in patients with esophageal cancer after radio (chemo) therapy.Methods:Clinical data of 331 esophageal cancer patients presenting with postoperative local recurrence admitted to our hospital from 2009 to 2014 were collected. The recurrence site, the effects of different radiotherapy doses on the prognosis of patients and the independent prognostic factors were retrospectively analyzed. The survival rate was calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox proportional hazard regression model.Results:The 1-, 3-and 5-year overall survival rates were 54.3%, 23.2% and 16.6%, respectively. The median overall survival was 13.4 months (95% CI: 11.7-15.0). The median survival of patients with radiotherapy doses< 60 Gy and ≥60 Gy was 10.8 and 13.9 months ( P=0.013). Stratified analysis showed that patients with age< 60 years, no smoking history, no drinking history, no family history, upper thoracic segment, left thoracotomy, N 0 staging, log odds of positive lymph nodes (LODDS)< 0.030, recurrence time ≥ 13.1 months and recurrence site ≥ 2 had better prognosis when receiving radiotherapy dose ≥ 60 Gy ( P=0.038, 0.033, 0.001, 0.003, 0.018, 0.010, 0.041, 0.039, 0.043 and 0.007). Moreover, the short-term clinical efficacy of patients treated with ≥60 Gy dose was significantly better than that of those with<60 Gy dose ( P<0.001), which did not increase the incidence of ≥grade 2 radiation-induced gastritis ( P=0.977) or radiation-induced pneumonitis ( P=0.444). Cox multivariate analysis showed that the LODDS size, prescription dose and short-term efficacy were the independent factors affecting clinical prognosis of patients ( P=0.006, 0.008 and<0.001). Conclusions:The recommended dose for esophageal cancer patients with local recurrence after radiotherapy (chemotherapy) is greater than or equal to 60 Gy. The results of this study need to be confirmed by prospective studies with a large sample size.

4.
Article in Chinese | WPRIM | ID: wpr-910376

ABSTRACT

Objective:To analyze the therapeutic effects and prognosis after radiotherapy (chemotherapy) of patients with postoperative recurrent esophageal cancer.Methods:This study analyzed 501 patients with postoperative recurrent esophageal cancer who were treated in the Radiotherapy Department of the Fourth Hospital of Hebei Medical University and met enrollment conditions. Among them, 274 patients received concurrent chemotherapy and radiotherapy. The analyses in this study focused on the survival after the retreatment, postoperative recurrence patterns, prognosis of retreatment, and prognostic factors affecting the retreatment. Meanwhile, statistical analysis was conducted using the software SPSS Statistics 19.0.Results:The time of postoperative recurrence was 0.3-87.4 months, with a median number of 11.6 months. The median survival time was 12.1 months after the retreatment. Among all the patients, 344 patients suffered from only local recurrence, while the remaining 157 patients experienced distant metastasis. According to multivariate analysis result, independent prognostic factors included gender, pN stage, lymph node positive logarithmic ratio (LODDS), the number of chemotherapy cycles, time of recurrence, and distant metastasis ( P < 0.05). Meanwhile, prognostic factors affecting the 344 patients with only local recurrence included the time of recurrence, the number of chemotherapy cycles, and prescription dose ( χ2=22.605, 13.957, 10.446; P< 0.05). The remaining 157 patients suffered from distant metastasis. The 1-, 3-, and 5-year survival rates of them were 43.3%, 9.1%, and 5.5%, respectively, and those of the patients with only local recurrence were 53.6%, 22.6%, and 16.4%, respectively. The differences were statistically significant (χ 2=10.786, P< 0.05). Conclusions:Radiotherapy (chemotherapy) is safe and effective for the treatment of recurrent esophageal cancer. However, it features poor prognosis for male patients with a late pN stage, a high LODDS, the number of chemotherapy cycles ≤ 2, the time of recurrence≤ 24 months, and distant metastasis.

5.
Article in Chinese | WPRIM | ID: wpr-910333

ABSTRACT

Objective:To study the prognostic impact of prognostic nutritional index (PNI) before radiotherapy in clinical stage Ⅲ esophageal cancer patients.Methods:We retrospectively reviewed 125 esophageal cancer patients with clinical stage Ⅲ undergoing definitive radiotherapy in Fourth Hospital of Hebei Medical University from 2013 to 2017. The PNI and nutritional risk index (NRI) were calculated before radiotherapy. The optimal cutoff value of PNI was determined by time-dependent receiver operating characteristics (ROC) at 49.925.The patients were divided into low PNI group(PNI<49.925) and high PNI group (PNI≥49.925). Based on NRI, the patients were divided into normal NRI group (NRI≥100) and abnormal NRI group (NRI<100). Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS) and to perform univariate analysis. The mutlivariate analysis was performed by Cox regression model.Results:PNI was positively correlated with hemoglobin ( r=0.505, P<0.001) and NRI ( r=0.594, P<0.001). The 1-, 3- and 5-year OS rates in the low PNI group were significantly lower than those of the high PNI group (67.5%, 27.3%, 11.4% vs. 85.4%, 45.8%, 27.4%, respectively, χ2=8.569, P<0.05). Moreover, the 1-, 3- and 5-year PFS rates in the low PNI group were obviously higher than those in the high PNI group (59.7%, 23.2%, 4.9% vs. 79.2%, 35.4%, 24.9%, respectively, χ2=6.715, P<0.05). Univariate analysis showed that GTV, radiotherapy dose, chemotherapy, albumin, NRI and PNI were significantly correlated with OS and PFS (OS: χ2=6.822, 4.326, 4.474, 13.123, 8.846, 8.569, P<0.05: PFS: χ2=7.869, 4.636, 5.874, 10.911, 8.544, 6.715, P<0.05). Multivariate analysis showed that GTV, radiotherapy dose and PNI were independent prognostic factors for OS ( P<0.05). And GTV, radiotherapy dose, chemotherapy and PNI were independent prognostic factors for PFS ( P<0.05). Conclusions:The PNI before radiotherapy is a significant and independent predictor for survival of clinical stage Ⅲ esophageal cancer patients. Based on simple and inexpensive standard laboratory measurements, PNI could be a promising prognostic biomarker for esophageal cancer patients.

6.
Article in Chinese | WPRIM | ID: wpr-885276

ABSTRACT

Objective:To explore the clinical features of Stewart-Treves syndrome in postoperative patients of breast cancer.Methods:The clinical data of 11 patients with Stewart-Treves syndrome after breast cancer surgery in Beijing Shijitan Hospital from Aug 2008 to Sep 2016 were retrospectively analyzed.Results:All the 11 patients were female , age ranging from 44 to 78 years.The main clinical manifestations included multiple skin and subcutaneous nodules , scattered red or purplish red rashes in the lymphedematous upper limbs, and sometimes in the chest wall. MRI showed multiple short T2 signal soft tissue nodules in skin and subcutaneous soft tissue. Histopathology showed heterogeneous endothelial cell-derived malignant tumor. Immunohistochemical staining showed positive CD31, CD34 and D2-40. These 11 patients had skin and subcutaneous tumor excision and biopsy, 4 had shoulder amputation, 4 received postoperative adjuvant chemo plus or radiotherapy. As of Feb 2020, 1 patient was alive, 9 died and 1 lost follow-up.Conclusions:Stewart-Treves syndrome is a rare complication of breast cancer, with poor prognosis and high mortality.

7.
Article in Chinese | WPRIM | ID: wpr-870483

ABSTRACT

Objective:To study the clinical effect of liposuction combined with lymphatico-venous anastomosis for treatment of breast cancer-related lymphedema(BCRL).Methods:From Nov 2015 to Nov 2017, 111 patients with BCRL admitted to the Department of Lymphatic Surgery at Beijing Shijitan Hospital were enrolled. The rank-sum test was used for statistical analysis. The frequencies of erysipelas episodes before and after combined surgeries were compared.Results:The mean upper limb circumference significantly decreased at 7 days[0.2 cm (-0.8, 1.1)], at follow-up[0.2 cm(-0.4, 1.0)]compared with that of preoperation[5.0 cm(4.1, 6.9)]( P<0.05). The mean upper limb volume significantly decreased at day 7[26 ml(-120, 155)], at follow-up[37 ml(-66, 165)]compared with preoperation[786 ml(632, 1 200)]( P<0.05). The incidence of erysipelas of the affected limbs significantly decreased after treatment. Furthermore, the softness and the feeling of heaviness of the affected limbs significantly improved after the combined procedures(all P<0.05). Conclusion:Liposuction combined with lymphatico-venous anastomosis is an effective method for the treatment of breast cancer-related lymphedema.

8.
Article in Chinese | WPRIM | ID: wpr-868724

ABSTRACT

Objective:To evaluate the effect of definitive radiotherapy with different doses on overall survival (OS) and identify the prognostic factors of patients with non-metastatic esophageal squamous cell carcinoma (ESCC).Methods:Clinical data of 2 344 ESCC patients treated with definitive radiotherapy (RT) alone or chemoradiotherapy from 2002 to 2016 in 10 hospitals were collected and analyzed retrospectively. After the propensity score matching (PSM)(1 to 2 ratio), all patients were divided into the low-dose group (equivalent dose in 2 Gy fractions, EQD 2Gy<60 Gy; n=303) and high-dose group (EQD 2Gy≥60 Gy; n=606) based on the dose of radiation. Survival analysis was conducted by Kaplan- Meier method. Multivariate prognostic analysis was performed by Cox′s regression model. Results:The median follow-up time was 59.6 months. After the PSM, the 1-, 3- and 5-year overall survival (OS) rate was 66.5%, 34.7%, 27.2% in the low-dose group, 72.9%, 41.7% and 34.7% in the high-dose group, respectively ( P=0.018). The 1-, 3-and 5-year progression-free survival rate was 52.2%, 27.2%, 23.1% in the low-dose group, 58.3%, 38.1% and 33.9% in the high-dose group, respectively ( P=0.001). The outcomes of univariate analysis indicated that cervical/upper esophagus location, early (stage Ⅱ) AJCC clinical stage, node negative status, tumor length ≤5 cm, receiving intensity-modulated radiation therapy (IMRT), receiving concurrent chemotherapy and EQD 2Gy≥60 Gy were closely associated with better OS (all P<0.05). Multivariable analysis demonstrated that tumor location, regional lymph node metastasis, concurrent chemotherapy and EQD 2Gy were the independent prognostic factors for OS (all P<0.05). Conclusion:Three-dimensional conformal or IMRT with EQD 2Gy≥60 Gy yields favorable survival outcomes for patients with locally advanced ESCC.

9.
Article in Chinese | WPRIM | ID: wpr-868699

ABSTRACT

Objective:To analyze the clinical prognosis of patients with cervical and upper thoracic esophageal squamous cell carcinoma treated with radical intensity-modulated radiotherapy (IMRT) with or without chemotherapy, and to explore the significance of elective lymph node irradiation (ENI).Methods:A retrospective analysis was performed on 309 patients with cervical and upper thoracic esophageal squamous cell carcinoma who underwent IMRT with or without chemotherapy in the Department of Radiology, the Fourth Hospital of Hebei Medical University. The prognostic factors were analyzed and patients receiving different irradiation methods were assigned into different group. The curative effect, toxicity and side effects were analyzed among different groups.Results:The 1-, 3-and 5-year overall survival (OS) and progression-free survival (PFS) were 76.7%, 37.4%, 19.3% and 59.7%, 27.4% and 14.4%, respectively, with median values of 26.8 and 15.5 months. Multivariate analysis showed that gender, cTNM staging and chemotherapy were the prognostic factors affecting the OS ( P=0.003, P<0.001, P=0.022), and gender, cTNM stage and radiation mode were the prognostic factors affecting the PFS ( P=0.016, P<0.001, P=0.008). After propensity score matching (PSM), the 1-, 3-, and 5-year OS and PFS were 77.2%, 39.3%, 20.0%, and 62.0%, 29.3%, and 15.4%, respectively, with median values of 27.1 and 18.2 months. Multivariate analysis showed that gender, cTNM staging and chemotherapy were the prognostic factors affecting the OS ( P=0.026, P<0.001, P=0.017); cTNM staging and irradiation mode were the prognostic factors affecting the PFS ( P<0.001, P=0.008). A subgroup analysis of chemotherapy showed that patients receiving 3-4 cycles of chemotherapy were preferred. The side effects of the patients were mainly grade 0 to 2, which could be tolerated. Conclusions:IMRT combined with or without chemotherapy is an efficacious treatment for patients with cervical and upper thoracic esophageal squamous cell carcinoma; ENI can improve the PFS of patients.

10.
Article in Chinese | WPRIM | ID: wpr-868556

ABSTRACT

Objective To evaluate the effect of locoregional risk factors of esophageal cancer on the recurrence of gross tumor volume (GTV) in patients with No esophageal squamous cell carcinoma after radical intensity-modulated radiotherapy (IMRT) and to evaluate its effect on the 10-year survival of patients.Methods Clinical data of 374 patients with clinical N0 esophageal squamous cell carcinoma who underwent radical IMRT in the Fourth Hospital of Hebei Medical University from 2005 to 2010 were retrospectively analyzed.Involved-field irradiation was performed in 284 patients and selective lymph node irradiation was given in 90 patients.Concurrent radiochemotherapy was conducted in 69l patients and sequential radiochemotherapy was performed in 38 patients.The survival analysis was carried out by Kaplan-Meier method.The prognosis analysis was performed by multivariate Cox's regression model.Results A total of 143 patients (38.2%) had recurrence in GTV.The maximum transverse diameter (GTV-D),GTV volume (GTV-V) and GTV volume/length (GTV-V/L) of GTV patients were significantly longer than those without recurrence in GTV (P=0.008,0.043,0.001).ROC curve analysis showed that the optimal diagnostic thresholds for GTV-D,GTV-L,GTV-V and GTV-V/L for GTV recurrence were 3.5 cm,5.5 cm,24.0 cm3 and 4.6 cm2,respectively (P=0.000,0.003,0.000 and 0.000),and the ratio of recurrence within GTV in the patient group was significantly greater than that in the smaller group (P=0.000,0.002,0.001 and 0.000).GTV-L and GTV-V/L were the independent risk factors of recurrence in GTV (P=0.021 and 0.009).The 3-,5-and 10-year survival rates of all patients in the whole group were 42.9%,23.2% and 7.9%,respectively.Multivariate analysis demonstrated that age,T stage,concurrent radiochemotherapy,GTV-D and GTV-V/L were the independent risk factors of survival (P=0.027,0.000,0.018,0.009 and 0.034).The main cause of death in patients with a survival time of more than 5 years was still associated with cancer.Conclusions The locoregional risk factors of esophageal cancer exert significant effect on the recurrence of GTV in patients with No esophageal squamous cell carcinoma undergoing radical radiochemotherapy,which can be utilized as the predicting markers.Both GTV-D and GTV-V/L are significantly correlated the 10-year survival of patients.

11.
Article in Chinese | WPRIM | ID: wpr-868540

ABSTRACT

Objective To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma,aiming to select the optimal treatment for these patients.Methods A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study.All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups.The composition ratio,prognostic factors and adverse events were analyzed between two groups.Results The median overall survival (OS) time was 35.5 months (95%CI:30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95%CI:19.00-28.00).According to the multivariate analysis results,all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group).Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038),and T stage and radiotherapy were the independent factors affecting DFS (P=0.002,0.032).The incidence of ≥ grade Ⅱ adverse events did not significantly differ between two groups (P=0.819,0.756).However,patients with combined chemotherapy experienced more adverse events.Conclusion ENI can prolong the OS and DFS of patients with clinical T2-3NoMo esophageal squamous cell carcinoma,and does not increase the incidence of severe adverse events.

12.
Article in Chinese | WPRIM | ID: wpr-868537

ABSTRACT

Objective:To evaluate the recurrence patterns of esophageal squamous cell carcinoma (ESCC) after radical surgery and analyze the predictors of post-recurrence survival (PRS).Methods:A total of 382 ESCC patients who developed recurrence after radical surgery were retrospectively reviewed from January 2007 to December 2011. All of them received salvage treatment after recurrence. The Univariate analysis was determined using the Kaplan-Meier method and log-rank test. Multivariate prognostic analysis was determined using the Cox proportional hazard model.Results:The 1-, 3-, 5-year overall survival (OS) rates were 80.9%, 35.6% and 20.4%, respectively. The median survival time and recurrence time were 29.2 months and 15.0 months. The 1-, 3-, 5-year PRS rates were 37.7%, 14.6% and 11.9%, respectively. The median PRS time was 10.2 months. Locoregional recurrence was noted at 462 sites among 382 patients including 20.5% (95/462) of sites in supraclavicular LN (lymph node), 10.0% (46/462) in anastomosis, 56.1% (259/462) in mediastinal regional LN and 13.4% (62/462) in upper abdominal LN. There were 156, 43, 82 and 101 patients treated with salvage radiotherapy, chemotherapy, chemoradiotherapy and palliative care after recurrence, respectively. The univariate analysis showed that T stage, N stage, TNM stage, recurrence site, number of recurrent regions and treatment regimen after recurrence were significantly correlated with PRS ( χ2=5.336, 4.292, 8.067, 7.482, 4.093, 76.426, P<0.05). Patients receiving salvage radiotherapy with the median dose of 60 Gy, were divided into <60 Gy group and ≥ 60 Gy group. The ≥60 Gy group had a better PRS than <60 Gy group ( χ2=8.320, P<0.05). Multivariate analysis showed that number of recurrent regions and treatment regimen were independent prognostic factors of PRS. Conclusions:Mediastinal and supraclavicular regions were the most common sites of recurrence in ESCC patients after radical surgery. Salvage radiotherapy and chemoradiotherapy could significantly improve PRS in recurrent ESCC patients.

13.
Article in Chinese | WPRIM | ID: wpr-868461

ABSTRACT

Objective:To analyze the effect of positive lymph node log ratio (LODDS) on the prognosis of postoperative patients with esophageal cancer, and analyze the effect of LODDS on the evaluation of the efficacy of patients receiving different postoperative adjuvant treatment.Methods:A total of 1 546 patients with esophageal cancer treated in the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The effect of LODDS on the prognosis of patients was retrospectively analyzed. The significance of LODDS in choosing different treatment options for patients after operation was further analyzed.Results:The 1-, 3- and 5-year survival rates were 87.5%, 61.7% and 52.2%, respectively. The result of area under curve(ROC)curve analysis show that -1.354 1 is the best cut-off point for LODDS. Multivariate analysis showed that gender, age, lesion location, degree of adhesion, adjuvant therapy, pTNM stage and LODDS were the independent factors affecting the patients ( P<0.05). After propensity-matched analysis(PSM)analysis, there were 205 patients in each group. Multivariate analysis showed that gender, degree of adhesion, adjuvant therapy, pTNM stage and LODDS were independent prognostic factors ( P<0.05). The result of stratified analysis showed that patients with small LODDS values had better prognosis (OS) in patients undergoing postoperative adjuvant therapy than patients in the surgery alone ( χ2=81.470, 5.182, P<0.05), but postoperative chemotherapy (POCT) and postoperative radiotherapy and chemotherapy (POCRT) had no significant difference in the OS of patients ( P>0.05). However, in the larger LODDS group, the OS of patients in the POCRT group was significantly better than the other two groups ( χ2=4.151, 24.020, P<0.05), and there was also a significant difference between the POCT and POCRT groups ( χ2=8.728, P<0.05). Conclusions:LODDS is an independent prognostic factor for postoperative patients with esophageal squamous cell carcinoma and can guide the choice of postoperative adjuvant therapy to a certain extent. This conclusion needs further clinical research to confirm.

14.
Article in Chinese | WPRIM | ID: wpr-868423

ABSTRACT

Objective:To investigate the prognosis and failure mode of patients with esophageal squamous cell carcinoma receiving selective lymph node irradiation (ENI).Methods:A total of 179 eligible patients with esophageal squamous cell carcinoma were retrospectively analyzed. The prognostic value of tumor-related factors, the influencing factors of short-term curative effect and prognosis of patients, and the single and multi factor indexes of affecting the overall survival rate (OS), progression free survival rate (PFS) and recurrence of patients were analyzed.SPSS 19.0 software was used for statistical analysis.Results:The 1, 3- and 5-year OS of the whole group were 77.1%, 40.1% and 26.0%, respectively, and 1-, 3- and 5-year PFS were 62.6%, 30.6%, and 20.3%, respectively. Multivariate analysis showed that hoarseness, cN stage, cTNM stage, GTV-transverse diameter (GTV-D) and GTV-volume/length (GTV-V/L) were independent factors affecting OS ( P<0.05). The sonar, cTNM staging, and short-term efficacy were independent factors affecting PFS ( P<0.05). Recurrence occurred in 75 patients (41.9%) in the whole group, and 61 patients (34.1%) had distant metastases. Among them, 9 patients (10.6%) had both recurrence and distant metastasis. Of the 75 patients with recurrence, 64(85.3%) had simple esophageal recurrence, 4(5.3%) had lymph node recurrence, and 7 (9.3%) had both. Recurrence occurred in 18 of the 63 patients who achieved CR after treatment. Only 2 patients had lymph node recurrence. Logistic multivariate analysis showed that the surrounding tissue/organ invasion, GTV-D and short-term were independent factors affecting the recurrence rate ( P<0.05). Conclusions:ENI is feasible in patients with esophageal squamous cell carcinoma, and the main mode of failure is esophageal recurrence. Pre-treatment sonar, larger GTV-D and GTV-V/L, more advanced clinical stage and poorer short-term efficacy are indicators of poor prognosis, while the peripheral tissue involvement, GTV-D and short-term efficacy are the independent factors that influence failure.

15.
Article in Chinese | WPRIM | ID: wpr-868419

ABSTRACT

Objective:To study the effects of immunity index and blood inflammatory markers pre- and post-radiotherapy on prognosis of esophageal cancer patients with clinical stage Ⅲ.Methods:A total of 84 esophageal cancer patients with clinical stage Ⅲ (T 4N 1M 0) in Fourth Hospital of Hebei Medical University were analyzed, from May 2010 to April 2012. Intensity-modulated radiotherapy was delivered with a dose of 56-66 Gy/1.8-2.0 Gy per fraction. Flow cytometry was used to analyze the distribution of T-lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) and natural killer cells (CD56) in the peripheral blood pre- and post- radiotherapy. Neutrophil-lymphocyte ratio (NLR) pre- and post- radiotherapy were also tested. The correlation of immunity index and blood inflammatory markers with prognosis was analyzed by univariate and multivariate analysis. Results:For all patients, the 1-, 3- and 5-year overall survival (OS) rates were 78.57%, 34.52% and 19.59%, respectively. The median OS time was 22.60 months. The 1-, 3- and 5-year progression free survival (PFS) rates were 69.05%, 27.38% and 12.09%, respectively. The median PFS time was 21.20 months. The objective response rate was 61.90%, with 11 patients of complete remission (CR) and 41 patients of partial remission (PR). Univariate analysis revealed that NLR before radiotherapy, T-lymphocyte subsets (CD3, CD4 and CD4/CD8) after radiotherapy were significantly associated with OS and PFS (OS: χ 2=7.851, 4.443, 8.381, 5.972, P<0.05, PFS: χ 2= 7.475, 6.290, 9.659, 8.738, P<0.05). Multivariate COX regression analysis showed that NLR before radiotherapy, T-lymphocyte subsets (CD4, CD4/CD8) after radiotherapy were independent prognostic factors for OS (χ 2=10.464, 4.292, 5.507, P<0.05). The NLR before radiotherapy and CD4/CD8 after radiotherapy were independent prognostic factors for PFS (χ 2=10.835, 8.545, P<0.05). Conclusions:Radiotherapy may influence the immune function. NLR before radiotherapy and CD4/CD8 after radiotherapy are of great value in predicting the prognosis of esophageal cancer patients.

16.
Article in Chinese | WPRIM | ID: wpr-868409

ABSTRACT

Objective To study the relationship between the dose-volume indexes and acute toxicity of intrathoracic stomach in esophageal cancer patients receiving radiotherapy after esophagectomy.Methods A total of 104 patients treated with postoperative radiotherapy followed by radical esophagectomy were enrolled.The dose-volume indexes of intrathoracic stomach were collected from treatment planning system.The ROC curve and logistic regression were performed to analyze the relationship between acute toxicity of intrathoracic stomach and clinical parameters,dose-volume indexes.Results A total of 29 patients (27.88 %) suffered from grade 2 or above acute toxicity.The ROC curve analysis showed that the dose-volume indexes including D D L5-L45 and V5-V50were associated with occurrence of grade 2 or above acute toxicity,The univariate analysis showed that location,D D L5-L45 and V5-V50 were significantly correlated with the incidence of grade 2 or above acute toxicity (P<0.05).The multivariate analysis showed that location,L5 and V35 were independent factors for incidence of grade 2 or above acute toxicity.The ROC curve analysis showed that cut-off values of L5 and V35 were 14.00 cm and 44.00%,respectively.And the rates of Grade 2 or above acute toxicity were 20.00% for L5> 14.00 cm and 38.64% for L5 ≥ 14.00 cm (x2 =4.473,P<0.05),14.08% for V35<44.00% and 57.58% for V35 ≥44.00% (x2 =7.263,P<0.05),respectively.The incidence of grade 2 or above acute toxicity was significantly higher in post-mediastinum stomach group than the other two groups (x2 =12.881,P<0.05).Conclusions Dosevolume index may be indicator to predict acute toxicity of intrathoracic stomach.It is recommended that post-mediastinum stomach should be chosen carefully if esophageal cancer patients require postoperative radiotherapy.

17.
Chinese Journal of Oncology ; (12): 139-144, 2020.
Article in Chinese | WPRIM | ID: wpr-799555

ABSTRACT

Objective@#To evaluate the prognostic factors of T1-2N0M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy.@*Methods@#The 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.@*Results@#The percentage of normal lung receiving at least 20 Gy (V20) was (18.65±7.20)%, with average dose of (10.81±42.05) Gy. The percentage of normal heart receiving at least 30 Gy (V30) 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.@*Conclusions@#Definitive radiotherapy is a promising therapeutic method in patients with T1-2N0M0 ESCC. Patients′ age, tumor diameter and tumor volume may impact patients′ prognosis.

18.
Article in Chinese | WPRIM | ID: wpr-799437

ABSTRACT

Objective@#To evaluate the effect of locoregional risk factors of esophageal cancer on the recurrence of gross tumor volume (GTV) in patients with N0 esophageal squamous cell carcinoma after radical intensity-modulated radiotherapy (IMRT) and to evaluate its effect on the 10-year survival of patients.@*Methods@#Clinical data of 374 patients with clinical N0 esophageal squamous cell carcinoma who underwent radical IMRT in the Fourth Hospital of Hebei Medical University from 2005 to 2010 were retrospectively analyzed. Involved-field irradiation was performed in 284 patients and selective lymph node irradiation was given in 90 patients. Concurrent radiochemotherapy was conducted in 69l patients and sequential radiochemotherapy was performed in 38 patients. The survival analysis was carried out by Kaplan-Meier method. The prognosis analysis was performed by multivariate Cox’s regression model.@*Results@#A total of 143 patients (38.2%) had recurrence in GTV. The maximum transverse diameter (GTV-D), GTV volume (GTV-V) and GTV volume/length (GTV-V/L) of GTV patients were significantly longer than those without recurrence in GTV (P=0.008, 0.043, 0.001). ROC curve analysis showed that the optimal diagnostic thresholds for GTV-D, GTV-L, GTV-V and GTV-V/L for GTV recurrence were 3.5 cm, 5.5 cm, 24.0 cm3 and 4.6 cm2, respectively (P=0.000, 0.003, 0.000 and 0.000), and the ratio of recurrence within GTV in the patient group was significantly greater than that in the smaller group (P=0.000, 0.002, 0.001 and 0.000). GTV-L and GTV-V/L were the independent risk factors of recurrence in GTV (P=0.021 and 0.009). The 3-, 5-and 10-year survival rates of all patients in the whole group were 42.9%, 23.2% and 7.9%, respectively. Multivariate analysis demonstrated that age, T stage, concurrent radiochemotherapy, GTV-D and GTV-V/L were the independent risk factors of survival (P=0.027, 0.000, 0.018, 0.009 and 0.034). The main cause of death in patients with a survival time of more than 5 years was still associated with cancer.@*Conclusions@#The locoregional risk factors of esophageal cancer exert significant effect on the recurrence of GTV in patients with N0 esophageal squamous cell carcinoma undergoing radical radiochemotherapy, which can be utilized as the predicting markers. Both GTV-D and GTV-V/L are significantly correlated the 10-year survival of patients.

19.
Article in Chinese | WPRIM | ID: wpr-799414

ABSTRACT

Objective@#To study the relationship between the dose-volume indexes and acute toxicity of intrathoracic stomach in esophageal cancer patients receiving radiotherapy after esophagectomy.@*Methods@#A total of 104 patients treated with postoperative radiotherapy followed by radical esophagectomy were enrolled. The dose-volume indexes of intrathoracic stomach were collected from treatment planning system. The ROC curve and logistic regression were performed to analyze the relationship between acute toxicity of intrathoracic stomach and clinical parameters, dose-volume indexes.@*Results@#A total of 29 patients (27.88 %) suffered from grade 2 or above acute toxicity. The ROC curve analysis showed that the dose-volume indexes including Dmax, Dmean, L5-L45 and V5-V50were associated with occurrence of grade 2 or above acute toxicity. The univariate analysis showed that location, Dmax, Dmean, L5-L45 and V5-V50 were significantly correlated with the incidence of grade 2 or above acute toxicity (P<0.05). The multivariate analysis showed that location, L5 and V35 were independent factors for incidence of grade 2 or above acute toxicity. The ROC curve analysis showed that cut-off values of L5 and V35 were 14.00 cm and 44.00%, respectively. And the rates of Grade 2 or above acute toxicity were 20.00% for L5>14.00 cm and 38.64% for L5≥14.00 cm (χ2=4.473, P<0.05), 14.08% for V35<44.00% and 57.58% for V35≥44.00% (χ2=7.263, P<0.05), respectively. The incidence of grade 2 or above acute toxicity was significantly higher in post-mediastinum stomach group than the other two groups (χ2=12.881, P<0.05).@*Conclusions@#Dose-volume index may be indicator to predict acute toxicity of intrathoracic stomach. It is recommended that post-mediastinum stomach should be chosen carefully if esophageal cancer patients require postoperative radiotherapy.

20.
Article in Chinese | WPRIM | ID: wpr-798799

ABSTRACT

Objective@#To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma, aiming to select the optimal treatment for these patients.@*Methods@#A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study. All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups. The composition ratio, prognostic factors and adverse events were analyzed between two groups.@*Results@#The median overall survival (OS) time was 35.5 months (95%CI : 30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95%CI: 19.00-28.00). According to the multivariate analysis results, all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group). Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038), and T stage and radiotherapy were the independent factors affecting DFS (P=0.002, 0.032). The incidence of ≥grade Ⅱ adverse events did not significantly differ between two groups (P=0.819, 0.756). However, patients with combined chemotherapy experienced more adverse events.@*Conclusion@#ENI can prolong the OS and DFS of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma, and does not increase the incidence of severe adverse events.

SELECTION OF CITATIONS
SEARCH DETAIL