放化疗分别联合内镜下射频消...及对生存时间和并发症的影响_金燕.pdf

海南医学2023年2月第34卷第4期Hainan Med J,Feb.2023.Vol.34,No.4放化疗分别联合内镜下射频消融和支架置入治疗晩期食管癌的疗效及对生存时间和并发症的影响金燕，白改艳，商博鑫，郭雪艳陕西省人民医院消化内科，陕西西安710068【摘要】目的比较放化疗联合内镜下射频消融与放化疗联合支架置入治疗晚期食管癌的疗效，并探讨其对患者生存时间和并发症的影响。方法选取2016年1月至2019年7月在陕西省人民医院消化内科治疗的148例晚期食管癌患者为研究对象，按简单随机化法分为支架组和射频消融组，每组74例，治疗后6个月，比较两组患者的临床疗效，以及治疗前后的血清肿瘤标志物细胞角蛋白片段19抗原21-1(Cyfra21-1)、鳞状上皮细胞癌抗原(SCC-Ag)、吞咽功能标准吞咽功能评定量表(SSA)、生活质量癌症患者生命质量测定量表体系之食管癌量表(QLICP-ES)；术后随访2年，比较两组患者的生存时间(中位生存时间、短期生存率)和并发症发生情况。结果治疗后6个月，射频消融组患者的缓解率为66.22%，明显高于支架组的45.95%，差异有统计学意义(P0.05)；治疗后6个月，两组患者的Cyfra21-1、SCC-Ag较治疗前降低，且射频消融组患者的Cyfra21-1和SCC-Ag分别为(2.270.75)g/L、(1.520.45)ng/mL，明显低于支架组的(2.690.81)g/L、(1.790.49)ng/mL，差异均有统计学意义(P0.05)；治疗后6 个月，两组患者的SSA、QLICP-ES较治疗前降低，差异均有统计学意义(P0.05)；射频消融组患者的短期生存率为94.59%，与支架组的90.54%比较差异无统计学意义(P0.05)；术后随访2年，射频消融组患者的中位生存时间为21个月，明显长于支架组的16个月，差异有统计学意义(Log rank P0.05)。结论放化疗联合内镜下射频消融治疗晚期食管癌疗效显著，相较于放化疗联合支架置入，其更能改善血清肿瘤标志物的表达，延长患者的生存时间，且安全性尚可，具有临床应用价值。【关键词】晩期食管癌；放化疗；支架置入；内镜下射频消融；生存时间；并发症【中图分类号】R735.1【文献标识码】A【文章编号】10036350（2023）04048405Efficacy of chemoradiotherapy combined with endoscopic radiofrequency ablation or stent placement in thetreatment of advanced esophageal cancer and effects on survival time and complications.JIN Yan,BAI Gai-yan,SHANG Bo-xin,GUO Xue-yan.Department of Gastroenterology,Shaanxi Provincial People s Hospital,Xi an 710068,Shaanxi,CHINA【Abstract】ObjectiveTo compare the efficacy of chemoradiotherapy combined with endoscopic radiofrequen-cy ablation and chemoradiotherapy combined with stent placement in the treatment of advanced esophageal cancer,andto explore the effects on survival time and complications of patients.MethodsA total of 148 patients with advancedesophageal cancer who were treated in Department of Gastroenterology,Shaanxi Provincial People s Hospital betweenJanuary 2016 and July 2019 were selected as the study subjects.They were divided into a stent group and radiofrequencyablation group by means of simple randomization method,with 74 patients in each group.The clinical efficacy at 6months after treatment,as well as serum tumor markers cytokeratin fragment 19 antigen 21-1(Cyfra21-1),squamouscell carcinoma antigen(SCC-Ag),swallowing function Standardized Swallowing Assessment(SSA),and quality oflife Quality of Life Instruments for Cancer Patient-Esophageal Cancer(QLICP-ES)before and after treatment werecompared between the groups.At 2 years of follow-up after surgery,the survival time(median survival time,short-termsurvival rate),and occurrence of complications were compared between the two groups.ResultsAt 6 months aftertreatment,the remission rate in radiofrequency ablation group(66.22%)was significantly higher than that in stent group(45.95%),P0.05.The levels of Cyfra21-1 and SCC-Ag in the two groups at 6 months after treatment were decreased com-pared with those before treatment,and the levels of Cyfra21-1 and SCC-Ag were(2.270.75)g/L and(1.520.45)ng/mLin radiofrequency ablation group,significantly lower than(2.690.81)g/L and(1.790.49)ng/mL in stent group(P0.05).At 6 months after treatment,the scores of SSA and QLICP-ES of the two groups were significantly reduced com-pared to those before treatment(P0.05).The short-term survival rate in radiofrequency 论著 doi:10.3969/j.issn.1003-6350.2023.04.005基金项目：陕西省自然科学基础研究计划项目(编号：2020JQ-944)。第一作者：金燕(1980)，女，博士，副主任医师，主要研究方向为乙肝母婴传播、消化道肿瘤治疗。通讯作者：郭雪艳(1982)，女，硕士，副主任医师，主要研究方向为胃癌发病机制，E-mail：。484Hainan Med J,Feb.2023.Vol.34,No.4海南医学2023年2月第34卷第4期食管癌为发病率仅次于胃癌的第二大消化恶性肿瘤，统计数据显示我国为食管癌发病率和死亡率较高的地区之一1。食管癌的发生与饮食习惯、遗传等因素相关，其早期临床症状隐匿且缺乏特异性，故临床绝大多数确诊患者疾病已进展为中晚期，食管癌切除术为食管癌常用手术方案，但手术的最佳时机为早期，中晚期患者手术效果不佳，病死率和复发率和术后患者吞咽功能改善效果均不够理想2。中晚期常采用以抑制肿瘤组织生长、改善吞咽功能为主要目的的综合治疗，放化疗为临床常用的根治术替代疗法，可用于治疗晚期恶性肿瘤，对控制肿瘤进展有一定疗效3。支架置入可通过将狭窄部位撑开改善病变部位梗阻状况，既往常用于治疗食管癌、化学烧伤等多种因素导致的食管狭窄，可有效扩张狭窄段食管，但支架可阻碍食管括约肌正常收缩，影响食管功能，对肿瘤的生长也并无抑制作用，存在较高复发风险4。内镜下射频消融可使食管肿瘤凝固坏死，不仅可抑制局部肿瘤生长，还可缓解食管狭窄5。本研究旨在探讨食管癌患者在常规放化疗的基础上加用内镜下射频消融或支架置入治疗的临床疗效和安全性，现报道如下：1资料与方法1.1一般资料选取2016年1月至2019年7月期间于陕西省人民医院消化内科接受治疗的148例晚期食管癌患者为研究对象。纳入标准：(1)符合中国食管癌放射治疗指南(2021年版)发布的晚期食管癌诊断标准6；(2)患者及家属充分了解研究内容、注意事项及风险，自愿签署知情同意书。排除标准：(1)诊断为转移性食管癌等非原发性食管癌者；(2)既往食管手术史；(3)合并多器官功能衰竭、免疫系统疾病者；(4)食管癌合并穿孔患者；(5)参与研究前接受其他手术治疗者。应用简单随机化法将患者分为支架组和射频消融组，每组74例。两组患者的一般资料比较差异均无统计学意义(P0.05)，具有可比性，见表1。本研究经医院伦理委员会批准。ablation group was not statistically different from that in stent group(94.59%vs90.54%,P0.05).The median survivaltime at 2 years of follow-up after surgery was significantly longer in radiofrequency ablation group compared with thatin stent group(21 monthsvs16 months,P0.05).ConclusionChemoradiotherapy combined with endoscopic radiofre-quency ablation has a significant efficacy in the treatment of advanced esophageal cancer,which can better improve theexpression of serum tumor markers and prolong the survival time compared to chemoradiotherapy combined with stentplacement,with acceptable safety.【Key words】Advanced esophageal cancer;Chemoradiotherapy;Stent placement;Endoscopic radiofrequency ab-lation;Survival time;Complications表1两组患者的临床资料比较x-s，例(%)Table 1Comparison of clinical data between the two groups x-s,n(%)组别