Zhongguo quanke yixue (Oct 2023)
Long-term Prognosis Analysis and Influencing Factors of Concurrent Chemotherapy and Radio-therapy for Cervical and Upper Thoracic Esophageal Squamous Cell Carcinoma
Abstract
Background The incidence of cervical and upper thoracic esophageal cancer is relatively low, with difficulties and controversies of mode in treatment, lack of convenient and accurate prognostic biomarkers, and poor overall prognosis. Objective To investigate the long-term prognosis of patients with cervical and upper thoracic esophageal squamous cell carcinoma under concurrent chemotherapy and radio-therapy (CCRT) . Methods Patients with cervical and thoracic upper esophageal cancer who received CCRT in the Department of Radiotherapy of the Fourth Hospital of Hebei Medical University from January 2013 to December 2017 were selected as the research subjects. General data, Eastern Cooperative Oncology Group (ECOG) score, tumor site, tumor length, TNM stage, radiotherapy dose, irradiation mode, chemotherapy regimen, toxic and side effects were collected by electronic medical record system, and neutrophil to lymphocyte ratio (dNLR) was calculated. The patients were divided into the dNLR<2.15 group (64 cases) and dNLR≥2.15 group (42 cases) according to dNLR. The patients were followed up, radiotherapy was reviewed once every 3 months for 1 year, once every 6 months for 2 to 5 years, and once every 1 year after 5 years, and overall survival (OS), progression-free survival (PFS), local relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were collected. Survival curves of OS, LRRFS and DMFS were plotted by Kaplan-Meier method. The single factor analysis of OS, PFS, LRRFS and DMFS was performed by Log-rank test. Multivariate Cox proportional hazard regression model was used to explore the influencing factors of OS, PFS, LRRFS and DMFS. Results As of the last follow-up, the OS rates at 3, 5 and 7 years were 55.7%, 43.0% and 37.8%, with a median OS of 47.5〔95%CI (29.4, 65.6) 〕months; the rates of PFS at 3, 5 and 7 years were 45.3%, 37.7% and 31.1%, with a median PFS of 30.7〔95%CI (21.1, 40.3) 〕months; the LRRFS rates in 3, 5 and 7 years were 50.9%, 41.4% and 33.5%, with a median LRRFS of 43.5〔95%CI (21.6, 65.4) 〕months; the DMFS rates at 3, 5 and 7 years were 49.1%, 38.6% and 34.4%, with a median DMFS of 34.7〔95%CI (20.7, 48.7) 〕months. Multivariate Cox proportional hazard regression analysis showed that TNM stage and irradiation mode were influencing factors of OS, PFS, LRRFS and DMFS (P<0.05), gender was an influencing factor of LRRFS (P<0.05), and dNLR was an influencing factor of PFS and DMFS (P<0.05). There were 10 cases, 25 cases, 32 cases, 9 cases and 11 cases of grade 2 and above acute radiation pneumonitis, acute radiation esophagitis, leukopenia, anemia and thrombocytopenia, respectively. Conclusion The long-term prognostic survival outcome of CCRT for cervical and upper thoracic esophageal squamous cell carcinoma was satisfactory and well tolerated. Local recurrence was the main failure pattern. Elective lymphatic drainage irradiation can significantly improve the prognosis of patients, which can be promoted clinically and dNLR has a predictive effect on long-term survival.
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