中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
  • BA、CA收录

中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (1): 36-41.doi: 10.12007/j.issn.0258-4646.2018.01.009

• 论著 • 上一篇    下一篇

基于病史、体征、血常规的食管癌预后评分系统的初步构建

裘敬平, 党军, 蔡峰, 李光   

  1. 中国医科大学附属第一医院放疗科, 沈阳 110001
  • 收稿日期:2017-09-20 出版日期:2018-01-30 发布日期:2017-12-23
  • 通讯作者: 李光 E-mail:13804058616@163.com
  • 作者简介:裘敬平(1981-),女,主治医师,博士.
  • 基金资助:
    辽宁省科技厅科学技术计划(2013225021)

Preliminary Establishment of a Scoring System Based on Medical History, Vital Signs, and Routine Blood Test for Prediction of the Prognosis of Esophageal Cancer

QIU Jingping, DANG Jun, CAI Feng, LI Guang   

  1. Department of Radiation Oncology, The First Hospital, China Medical University, Shenyang 110001, China
  • Received:2017-09-20 Online:2018-01-30 Published:2017-12-23

摘要: 目的 通过分析临床病史、体征、血常规化验结果,筛选预测不可手术的局部晚期食管鳞状细胞癌同期放化疗的预后因素,并初步建立预测评分系统。方法 收集75例接受三维适形或调强放疗、不可手术的局部晚期食管鳞癌患者资料,分析体质量下降>5%、进食困难、返黏液、饮水呛咳、音哑、胸痛、咳嗽、吸烟、饮酒、不良饮食习惯、家族肿瘤史、放疗前及放疗结束时血常规、肝肾功能化验指标的变化与预后的相关性,并选择相关因素构建评分系统。采用受试者工作特征曲线评估预测模型的预测效能,Hosmer-Lemeshow拟合优度检验拟合度。结果 纳入的75例局部晚期食管鳞癌患者中,单因素分析显示体质量下降>5%、不良饮食习惯、白细胞显著下降与局部晚期食管鳞癌同期放化疗的预后具有一定相关性(P=0.047、0.074、0.074),进行Cox多因素分析并建立预后评分系统,体质量下降>5%计为1.5分,存在不良饮食习惯计为1分,白细胞显著下降(>2.0×109/L)计为1分,总得分>2.25为高死亡风险,敏感度为0.559,特异度为0.805。结论 本研究通过简单、实用的食管鳞癌放化疗预后评分系统,可以大体预测不可手术的局部晚期食管鳞癌同期放化疗后的死亡风险。

关键词: 食管癌, 同步放化疗, 预后, 体质量下降

Abstract: Objective To screen predictors for the prognosis of patients with inoperable locally advanced esophageal squamous carcinoma (LAESC) who are undergoing concurrent chemoradiotherapy and establish a preliminary scoring system. Methods The data of 75 patients with inoperable LAESC who were undergoing intensity-modulated radiation therapy (IMRT) were collected and analyzed to determine whether the prognosis was associated with medical history, vital signs, routine blood test results, and liver and kidney functions test results before and at the end of radiotherapy. The prediction efficacy of the prediction model was assessed using the receiver-operating characteristic curve. The degree of fitting was tested using the Hosmer-Lemeshow goodness-of-fit test. Results Seventy-five patients with LAESC were included. The univariate analysis indicated that the prognosis of the patients with LAESC who were undergoing concurrent chemoradiotherapy was associated with weight loss of more than 5%, poor dietary habit, and significant decrease in white blood cell count (P=0.047, 0.074, and 0.074). The multivariate Cox model was conducted, and a scoring system for prediction of prognosis was established. The scores were 1.5 for weight loss of more than 5%, 1 for poor dietary habit, and 1 for a significant decrease in white blood cell count (more than 2.0×109/L). A total score of more than 2.25 indicated a high mortality risk, with a sensitivity of 0.559 and specificity of 0.805. Conclusion The simple and practical scoring system for prediction of prognosis of patients with LAESC in this study could generally predict the mortality risk of patients with inoperable LAESC who are undergoing concurrent chemoradiotherapy.

Key words: esophageal squamous carcinoma, concurrent chemoradiotherapy, prognosis, weight loss

中图分类号: 

  • R817.5
[1] 中国非手术治疗食管癌临床分期专家小组. 非手术治疗食管癌的临床分期标准(草案)[J]. 中华放射肿瘤学杂志, 2010, 19(3):179-180. DOI:10.3760/cma.j.issn.1004-4221.2010.03.001.
[2] SHUCHAI Z, WEINAN Y, JUAN L, et al. A comparative study of new clinical staging systems for esophageal carcinoma treated with non-surgical therapy[J]. Chin J Radiat Oncol, 2016, 25(2):109-113. DOI:10.3760/cma.j.issn.1004-4221.2016.02.005.
[3] MIRINEZHAD SK, JANGJOO AG, SEYEDNEJAD F, et al. Impact of tumor length on survival for patients with resected esophageal cancer[J]. Asian Pac J Cancer Prev, 2014, 15(2):691-694. DOI:DOI:http://dx.doi.org/10.7314/APJCP.2014.15.2.691.
[4] TAMANDL D, GORE RM, FUEGER B, et al. Change in volume parameters induced by neoadjuvant chemotherapy provide accurate prediction of overall survival after resection in patients with oesophageal cancer[J]. Eur Radiol, 2016, 26(2):311-321. DOI:10.1007/s00330-015-3860-7.
[5] CHHABRA A, ONG LT, KUK D, et al. Prognostic significance of PET assessment of metabolic response to therapy in oesophageal squamous cell carcinoma[J]. Br J Cancer, 2015, 113(12):1658-1665. DOI:10.1038/bjc.2015.416.
[6] GRAY RT, O'DONNELL ME, SCOTT RD, et al. Impact of nutritional factors on survival in patients with inoperable oesophageal cancer undergoing self-expanding metal stent insertion[J]. Eur J Gastroenterol Hepatol, 2011, 23(6):455-460. DOI:10.1097/MEG.0b013e3283469761.
[7] DANDARA C, ROBERTSON B, DZOBO K, et al. Patient and tumour characteristics as prognostic markers for oesophageal cancer:a retrospective analysis of a cohort of patients at Groote Schuur Hospital[J]. Eur J Cardiothorac Surg, 2016, 49(2):629-634. DOI:10.1093/ejcts/ezv135.
[8] KAMACHI K, OZAWA S, HAYASHI T, et al. Impact of body mass index on postoperative complications and long-term survival in patients with esophageal squamous cell cancer[J]. Dis Esophagus, 2016, 29(3):229-235. DOI:10.1111/dote.12327.
[9] WU N, CHEN G, HU H, et al. Low pretherapeutic serum albumin as a risk factor for poor outcome in esophageal squamous cell carcinomas[J]. Nutr Cancer, 2015, 67(3):481-485. DOI:10.1080/01635581.2015.1004726.
[10] BOLLSCHWEILER E, SCHRODER W, HOLSCHER AH, et al. Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the oesophagus[J]. Br J Surg, 2000, 87(8):1106-1110. DOI:10.1046/j.1365-2168.2000.01474.x.
[11] OCAMA P, KAGIMU MM, ODIDA M, et al. Factors associated with carcinoma of the oesophagus at Mulago Hospital, Uganda[J]. Afr Health Sci, 2008, 8(2):80-84.
[12] KUANG J J, JIANG Z M, CHEN Y X, et al. Smoking exposure and survival of patients with esophagus cancer:a systematic review and meta-analysis[J]. Gastroenterol Res Pract, 2016, 2016:7682387. DOI:10.1155/2016/7682387.
[13] HUANG Q, LUO K, YANG H, et al. Impact of alcohol consumption on survival in patients with esophageal carcinoma:a large cohort with long-term follow-up[J]. Cancer Sci, 2014, 105(12):1638-1646. DOI:10.1111/cas.12552.
[14] TAGHAVI N, BIRAMIJAMAL F, SOTOUDEH M, et al. Association of p53/p21 expression with cigarette smoking and prognosis in esophageal squamous cell carcinoma patients[J]. World J Gastroenterol, 2010, 16(39):4958-4967. DOI:doi:10.3748/wjg.v16.i39.4958.
[15] WANG S, TAKAYAMA K, TANAKA K, et al. Nicotine induces resistance to epidermal growth factor receptor tyrosine kinase inhibitor by alpha1 nicotinic acetylcholine receptor-mediated activation in PC9 cells[J]. J Thorac Oncol, 2013, 8(6):719-725. DOI:10.1097/JTO.0b013e31828b51d4.
[16] YAMASHITA T, KATO K, LONG NK, et al. Effects of smoking and alcohol consumption on 5-fluorouracil-related metabolic enzymes in oral squamous cell carcinoma[J]. Mol Clin Oncol, 2014, 2(3):429-434. DOI:10.3892/mco.2014.267.
[17] OUYANG PY, SU Z, MAO YP, et al. Prognostic impact of cigarette smoking on the survival of patients with established nasopharyngeal carcinoma[J]. Cancer Epidemiol Biomarkers Prev, 2013, 22(12):2285-2294. DOI:10.1158/1055-9965.epi-13-0546.
[18] FENG JF, LIU JS, HUANG Y. Lymphopenia predicts poor prognosis in patients with esophageal squamous cell carcinoma[J]. Medicine (Baltimore), 2014, 93(27):e257. DOI:10.1097/md.0000000000000257.
[19] KOU F, LU Z, LI J, et al. Pretreatment lymphopenia is an easily detectable predictive and prognostic marker in patients with metastatic esophagus squamous cell carcinoma receiving first-line chemotherapy[J]. Cancer Med, 2016, 5(5):778-786. DOI:10.1002/cam4.638.
[20] GODET Y, DOSSET M, BORG C, et al. Is preexisting antitumor CD4 T cell response indispensable for the chemotherapy induced immune regression of cancer?[J]. Oncoimmunology, 2012, 1(9):1617-1619. DOI:10.4161/onci.21513.
[1] 徐国帅, 蔡相军, 陈江波, 吕庆, 刘洪涛. AEG-1和CHD5在胃癌中的表达及其临床意义[J]. 中国医科大学学报, 2018, 47(9): 797-802.
[2] 马艳梅, 常箫匀. 结直肠癌患者围手术期肠内外联合营养支持与预后的关系[J]. 中国医科大学学报, 2018, 47(7): 604-608.
[3] 姜文娟, 刘文静, 李晓曦, 沈雪莉. 1例急性原发性胼胝体变性病例的回顾分析[J]. 中国医科大学学报, 2018, 47(7): 657-659.
[4] 芦婷婷, 王治博. 术前血浆纤维蛋白原和D-二聚体水平与结直肠癌预后的关系[J]. 中国医科大学学报, 2018, 47(6): 513-518.
[5] 武佳科, 田春阳, 何东旭, 宋佳, 于彤彤, 孙志军, 孙兆青. 休克指数对行经皮冠状动脉介入治疗的急性心肌梗死患者长期预后的预测价值[J]. 中国医科大学学报, 2018, 47(6): 522-526.
[6] 刘晓, 王彤, 蒋怡芳, 王媛. 病原学阳性与阴性的医院获得性肺炎患者临床特征及预后比较[J]. 中国医科大学学报, 2018, 47(5): 406-410,414.
[7] 唐玲荣, 李光. 食管癌放射治疗中或放射治疗后并发食管穿孔的临床分析[J]. 中国医科大学学报, 2018, 47(5): 439-442.
[8] 俞达辉, 吴道立, 袁冲, 褚文炎. 癌组织中CD45RO表达水平与肺腺癌患者临床病理特征及生存率的关联分析[J]. 中国医科大学学报, 2018, 47(5): 448-453.
[9] 邵洋, 胡延平, 刘勇. 慢性淋巴细胞白血病患者长链非编码RNA RP5-180C18.1的表达及其预后评价作用[J]. 中国医科大学学报, 2018, 47(4): 341-345.
[10] 张苏宁, 刘宗昂. 小细胞肺癌中DBC1的表达及预后相关性研究[J]. 中国医科大学学报, 2018, 47(3): 222-225.
[11] 王鸾, 蔡雪, 赵敏. 急性百草枯中毒死亡危险因素分析[J]. 中国医科大学学报, 2018, 47(3): 237-239,243.
[12] 李蕙伊, 刘畅, 赵洋子, 曾仁庆, 甘淼, 王涛, 于诗源, 崇巍. 急诊科成人创伤患者院内死亡危险因素分析[J]. 中国医科大学学报, 2018, 47(2): 128-131.
[13] 贡鸣, 何天宇, 裘敬平, 李光. 6种常见肿瘤患者初治时外周血T淋巴细胞亚群数量及临床特征[J]. 中国医科大学学报, 2018, 47(12): 1119-1122.
[14] 赵雪峰, 赵美兰, 许广大. TMPRSS4在胃癌中的表达及其临床意义[J]. 中国医科大学学报, 2018, 47(11): 969-974.
[15] 赵轲, 张永建, 刘奇, 徐迪, 陈宝钧. miR-107与非小细胞肺癌的临床病理特征及预后的关联[J]. 中国医科大学学报, 2018, 47(10): 933-938.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA