寡转移性食管鳞癌化免治疗联合放疗的最佳时序及预后影响因素
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R735.1

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四川省南充市市校合作自由探索项目(20SXQT0071);


Preliminary exploration of the optimal timing of chemoimmunotherapy combined with radiotherapy for oligometastatic esophageal squamous carcinoma and analysis of prognostic influencing factors
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    摘要:

    目的:探讨寡转移性食管鳞癌化免治疗联合放疗的最佳时序及预后影响因素。方法:选取71例接受化免治疗联合放疗治疗的寡转移性食管鳞癌患者为研究对象。根据化免治疗时间不同分为先放疗组(化免治疗前接受放疗,n=21)、同步放疗组(化免治疗开始4个周期内接受放疗,n=29)及序贯放疗组(化免治疗开始4个周期后接受放疗,n=21),比较三组患者临床疗效[疾病控制率(DCR)、无进展生存期(PFS)、总生存期(OS)]及不良反应发生情况;根据中性粒细胞与淋巴细胞比值(NLR)分为低NLR组(NLR<2.33,n=32)和高NLR组(NLR>2.33,n=39),比较两组患者OS;单因素及多因素Cox分析影响寡转移性食管癌患者预后的因素。结果:先放疗组、同步放疗组、序贯放疗组患者DCR比较,差异无统计学意义(33.3%vs.44.8%vs.52.4%,P>0.05);中位PFS比较,差异无统计学意义(11.9个月vs.17.6个月vs.17.5个月,P>0.05);中位OS比较,差异有统计学意义[18.4个月(95%CI:13.1~23.7)vs. 21.7个月(95%CI:17.8~25.7)vs.16.5个月(95%CI:9.9~23.1),P<0.05]。同步放疗组患者OS优于序贯放疗组(P<0.05)。患者对治疗相关不良反应均可耐受,毒副反应多为1~2级,包括骨髓抑制、肺炎、肝肾功能异常等,三组患者毒性反应发生率比较,差异无统计学意义(P>0.05)。低NLR组和高NLR组患者OS比较,差异有统计学意义[23.3个月(95%CI:19.6~27.0)vs.16.6个月(95%CI:15.1~18.1),P<0.05]。单因素及多因素COX分析显示,NLR是影响寡转移性食管癌患者预后的独立因素(HR=4.17,95%CI:2.17~8.00,P<0.05)。结论:化免治疗寡转移性食管鳞癌患者,在化免治疗四周期内加入放疗(即化免治疗同步放疗)可延长患者OS且不增加治疗相关不良反应。NLR可作为寡转移性食管癌患者化免联合放疗的预后标志物,治疗前高NLR提示预后不良。

    Abstract:

    Objective: To explore the optimal timing of chemoimmunotherapy combined with radiotherapy for oligometastatic esophageal squamous carcinoma and analyze the prognostic factors. Methods: 71 patients with oligometastatic esophageal squamous carcinoma who received chemoimmunotherapy combined with radiotherapy were selected as research subjects, and were divided into three groups according to the timing of radiotherapy relative to chemoimmunotherapy: The first radiotherapy group (receiving radiotherapy before chemoimmunotherapy, n = 21), The synchronous radiotherapy group (receiving radiotherapy within four cycles from the start of chemoimmunotherapy, n = 29), The sequential radiotherapy group (receiving radiotherapy after four cycles from the start of chemoimmunotherapy, n = 21). Clinical efficacy [disease control rate (DCR), progression-free survival (PFS), overall survival (OS)] and incidence of adverse reactions were compared among the three groups. According to the neutrophil-to-lymphocyte ratio (NLR), patients were further divided into a low NLR group (NLR 2.33, n = 39), and their overall survival (OS) was compared. Univariate and multivariate Cox regression analyses were conducted to identify factors affecting the prognosis of patients with oligometastatic esophageal cancer. Results: The DCR for the first radiotherapy group, synchronous radiotherapy group, and sequential radiotherapy group were 33.3%, 44.8%, and 52.4%, respectively. There was no statistically significant difference in DCR among the three groups (P > 0.05). The median PFS for the first, synchronous, and sequential radiotherapy groups were 11.9, 17.6, and 17.5 months, respectively, with no statistically significant difference among the three groups (P > 0.05). The median OS for the first radiotherapy group, synchronous radiotherapy group, and sequential radiotherapy group was 18.4 months (95% CI: 13.1–23.7), 21.7 months (95% CI: 17.8–25.7), and 16.5 months (95% CI: 9.9–23.1), respectively. The differences in OS among the three groups were statistically significant (P 0.05). The OS for the low NLR group and the high NLR group was 23.3 months (95% CI: 19.6–27.0) and 16.6 months (95% CI: 15.1–18.1), respectively (P < 0.05). Both univariate and multivariate analyses indicated that NLR was an independent prognostic factor for patients with oligometastatic esophageal cancer (HR = 4.17, 95% CI: 2.17–8.00, P < 0.05). Conclusion: For patients with oligometastatic esophageal squamous carcinoma, initiating radiotherapy within four weeks of starting chemoimmunotherapy (i.e., concurrent chemoimmunotherapy and radiotherapy) prolongs overall survival without increasing treatment-related adverse effects. NLR is a valuable prognostic marker in this setting, and a high pretreatment NLR suggests a poorer prognosis.

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徐甜;皈燕;.寡转移性食管鳞癌化免治疗联合放疗的最佳时序及预后影响因素[J].川北医学院学报,2026,41(1):83-88.

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  • 在线发布日期: 2026-01-30
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