| Objective: To analysis the differences in prognosis and adverse reactions between the FP(5-fluorouracil+cisplatin)and TP(paclitaxel+cisplatin)regimens of chemoradiotherapy in esophageal squamous cell carcinoma,and to study whether the patients of esophageal squamous cell carcinoma can benefit from consolidation chemotherapy after concurrent chemoradiotherapy.Methods:1 The clinical data of 744 esophageal squamous cell carcinoma patients treated with definitive radiotherapy from January 2010 to December 2015 were retrospectively analyzed.There were 206 patients with complete Clinical data and treated with chemoradiotherapy in FP or TP regimens.The short-term efficacy,survival and local recurrence and adverse reactions were observed and compared in the 206 cases treated with chemoradiotherapy in FP or TP regimens.2 Propensity score matching analysis was used to balance the variables differences of 123 patients treated with concurrent chemoradiotherapy in the 206 patients treated with chemoradiotherapy in FP or TP regimens.Two groups were matched according to 1:1 and a total of 100 patients were successfully matched.Comparison of prognosis and toxicities was done between the FP and TP groups.The analysis was done to observe if the patients could benefit from consolidation chemotherapy after concurrent chemoradiotherapy.Results:1 In the FP group of 206 patients,CR was achieved in 28.8 %(32cases),PR 67.6 %(75 cases),NR 3.6 %(4 cases).The CR,PR and NRwas 27.4 %(26cases),70.5%(67cases),2.1%(2cases)in TP group,respectively.The response rate(CR+PR)of two groups was 96.4% and97.9% respectively(χ2=0.000,P=0.996).The 1-,3-and 5-year overall survival rates and local control rates of all patients were 76.5%,44.3%,33.2% and 69.8%、50.1%、42.2%,respectively.The 1-,3-and 5-year overall survival rates of FP and TP group were 77.3%,45.3%,35.9%and 75.5%,40.3%,27.4% respectively(χ2=0.324,P=0.569).The 1-,3-and 5-year local control rates of FP and TP group were 66.5%,50.4%,43.9% and 73.7%,49.3%,39.9%,respectively(χ2=0.011,P=0.915).Adverse reaction analysis suggested TP regimen had higher occurrence rate in bone marrow suppression(χ2=20.593,P=0.000)and lower in gastrointestinal reaction(χ2=14.122,P=0.007)than FP regimens and others were not significant different.Univariate analysis suggested that age,tumor location,chemotherapy method,short-term efficacy were the prognostic factor for local control and age,tumor location,tumor length,M stages,short-term efficacy was the prognostic factor for survival.Multivariate analysis suggested that age,tumor location,chemotherapy method was the prognostic factor for local control and age,tumor location,short-term efficacy was the prognostic factor for overall survival.2 After propensity scores matching,100 patients were included in the analysis.In the FP group,CR was 38.0 %(19 cases),PR was 60.0%(30 cases),NR was 2.0 %(1 cases).The CR and PR and NR was 28.0%(14cases),70.0%(35cases),2.0%(1cases)in TP group,respectively.The response rate(CR+PR)of two groups was 98.0% and 98.0%respectively(χ2=0.975,P=0.323).The 1-,3-and 5-year overall survival rates and local control rates of all patients were 74.9%,42.0%,26.7% and71.4%,49.2%,38.3% respectively.The 1-,3-and 5-year overall survival rates of FP and TP group were 76.0%,48.7%,30.2% and 73.8%,33.7%,22.5%,respectively(χ2=1.028,P=0.311).The 1-,3-and 5-year local control rates of FP and TP group were 69.3%,50.6%,38.9% and 73.5%,47.7%,35.4%,respectively(χ2=0.043,P=0.835).Adverse reaction analysis suggested TP regimen had higher occurrence rate in bone marrow suppression than FP regimens(χ2=16.544,P=0.000)and others were not significant difference.Univariate analysis suggested that tumor location was the prognostic factor for local control and tumor location,tumor length,M stages,KPS score was the prognostic factor for survival.Multivariate analysis suggested that tumor location was the prognostic factor for local control and survival and KPS score was the prognostic factor for survival.The 100 patients were successfully propensity score matched were divided into two groups,consolidation chemotherapy after concurrent chemoradiotherapy group(n=55)and no consolidation chemotherapy group(n=45).The 1-,3-and 5-year overall survival rates of the two group were 76.0%,39.1%,23.1% and 73.3%,45.2%,31.6%respectively(χ2=0.225,P=0.635).The 1-,3-and 5-year local control rates of the two group were 71.0%,47.2%,33.6% and 71.7%,51.4%,41.5%,respectively(χ2=0.040,P=0.842).The 1-,3-and 5-year distant metastasis free survival rates of The two group were 59.9%,32.0%,23.2% and63.7%,43.3%,29.2%,respectively(χ2=0.407,P=0.523).There is no significant difference in survival,local control and distant metastasis free survival rates between two groups.The incidence of grade 3 or higher bone marrow suppression was 7.3% and no grade 3 or higher gastrointestinal reactions occurred during consolidation chemotherapy.The adverse reaction analysis of Radiation dermatitis(χ2=0.021,P=0.886),esophagitis(χ2=0.254,P=0.614),pneumonitis(χ2=0.151,P=0.698)was not statistically significant between the two groups.Conclusion:1 For esophageal squamous cell carcinoma treated with chemoradiotherapy,there is no significant difference in survival and local control between FP and TP,but with higher hematological toxicities and lower gastrointestinal reaction in TP regimen.Multivariate analysis suggested that the elderly,upper location of primay tumor,concurrentchemoradiotherapy confer a better local control,and the elderly,upper location of primay tumor,good tumor response confer a better survival.2 For esophageal squamous cell carcinoma treated with concurrent chemoradiotherapy,there is no significant difference in survival and local control between FP and TP,but with higher hematological toxicities in TP regimen,especially the IV grade.Multivariate analysis suggested that tumor location of upper of patients with upper location of primay tumor had a better local control and survival,and the patients with high scores of KPS score has a better survival.3 Consolidation chemotherapy after concurrent chemoradiotherapy could not further improve survival,local control and distant metastasis free survival rates of patients with esophageal squamous cell carcinoma,though the toxicity is tolerable. |
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