| Objective:This study retrospectively analyzed the effective,toxicity and the independent factors effect on prognosis of induction chemotherapy followed by chemoradiotherapy compared to chemoradiotherapy alone in patients with non-surgical locally advanced esophageal squamous cell carcinoma.We explore the prognostic factors that may affect the over survival of patients to analyze the survival benefits between induction chemotherapy followed by chemoradiotherapy and chemoradiotherapy.Methods:We retrospectively analyzed the 94 patients’ clinical data,and these patients were pathologically diagnosized as advanced esophageal squamous cell carcinoma and and received induction chemotherapy followed by concurrent chemoradiotherapy or concurrent chemoradiotherapy.Among them,45 cases were given induction chemotherapy followed by concurrent chemoradiotherapy（IC+CCRT）（treatment group）,and 49 cases were given concurrent chemoradiotherapy（CCRT）（control group）.The radiotherapy technique was intensity-modulated radiotherapy,which was administered in both arms.Prescribed dose: 6MV-X-ray,GTV60-68Gy/28-34 fractions,CTV50.4-59.4Gy/28-34 fractions.The regimens of induction chemotherapy is DDP+Paclitaxel（TP）,and the concurrent chemotherapy regimen was DF regimen or single-agent fluorouracil regimen.The early and late toxic and side effects of the patients were observed,and the short-term response rate,progression-free survival and overall survival were evaluated,and the survival benefit was analyzed.Univariate and multivariate survival analysis was performed,and two groups of patients were divided into high-risk,intermediate-risk,and low-risk groups according to the results of risk factors,and the progression-free survival rate and overall survival rate between subgroups were analyzed.Logistic regression analyzed the relationship between each main index and the short-term efficacy of the treatment group,receivers’ operating curve（ROC）were used,and the corresponding area under the curve（AUC）value were calculated,and the blood tumor index levels were tested to predict the treatment group.The value of poor recent efficacy.Results:1.After one month of radiotherapy,the short-term response rate was observed.The overall response rate（CR+PR）was 73.3% in the induction chemotherapy followed by concurrent chemoradiotherapy group and 53.1% in the concurrent chemoradiotherapy group,with a statistically significant difference,where P value is0.042.2.The 1,2,3-year overall survival rates of the treatment group and the control group were 87.3%,45.9%,21.6%,and 94.9%,67.0%,and 33.9%,respectively,and the median overall survival was 24 months vs 33 months.Log-rank test was performed,and there was no statistical significance,where P value is 0.056.The 1,2,3-year progression-free survival rates of the treatment group and the control group were61.6%,32.5%,16.2%,and 71.8%,44.2%,and 29.5%,respectively,and the median progression-free survival was 20 months vs 25 months.Log-rank test was performed,and no significant difference was found in recurrence-free survival between the two groups,where P value is 0.105.3.The common adverse reactions in the two groups were blood system toxicity,gastrointestinal reaction,liver and kidney function damage,radiation pneumonitis,radiation esophagitis,etc.The incidence of grade III-IV acute radiation esophagitis in the treatment group was higher than that in the control group（24.4% vs 8.4%）,which shows a significant difference,where P value is 0.031.4.Multivariate analysis indicated that clinical stage and progression-free survival time were independent prognostic factors（P=0.045 and 0.000）.According to prognostic factors（clinical stage and progression-free survival time）,the two groups were divided into low-risk,intermediate-risk and high-risk groups.The median oral survival time of the low-risk,intermediate-risk and high-risk groups in the treatment group was 38 months and 19 Month and 16 months,and there was a huge statistical significance among these groups,where P value is P=0.000.The median progress free survival time of the low-risk,intermediate-risk and high-risk groups in the treatment group was 27 months and 8 Month and 6 months,and there was a huge statistical significance,where P value is P=0.000.5.The median oral survival time of low-risk,intermediate-risk,and high-risk groups in the treatment group and control group were 38 months,19 months,16 months,and36 months,19 months,12 months,respectively.There was no significant difference between the low-risk,intermediate-risk and high-risk groups in the treatment group and the control group（low-risk groups P value 0.363,intermediate-risk groups P value 0.264,high-risk groups P value 0.177）.The median progress free survival time of low-risk,intermediate-risk,and high-risk groups in the treatment group and control group were 27 months,8 months,6 months,and 35 months,8 months,8months,respectively.There was no significant difference between the high-risk,intermediate-risk and low-risk groups in the treatment group and the control group（low-risk groups P value 0.381,intermediate-risk groups P value 0.696,high-risk groups P value 0.184）.6.According to the short-term curative effect,the treatment group was divided into the effective group（CR+PR）with 33 cases and the ineffective group（SD+PD）with 12 cases.Logistic regression analysis showed that serum CEA overexpression was a risk factor for poor short-term curative effect in the treatment group（P =0.001）;the results of drawing the ROC curve showed that the AUC=0.867 of serum CEA level in predicting the poor prognosis of non-surgical patients who were diagonised as advanced esophageal squamous cell carcinoma after induction chemotherapy followed by chemoradiotherapy,which has a certain predictive value.Conclusion:1.Induction chemotherapy followed by concurrent chemoradiotherapy show higher overall response rate,but it does not prolong the overall survival time.2.The incidence of severe acute radiation esophagitis in induction chemotherapy group is more frequent.3.Induction chemotherapy followed by concurrent chemoradiotherapy can achieve longer survival time for patients with earlier clinical stage and longer progression-free survival time.4.Serum CEA level is related to the short-term efficacy of induction chemotherapy followed by concurrent chemoradiotherapy and can be used to predict the short-term efficacy. |
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