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目的 :探讨不同方案的二线化疗治疗食管鳞癌的疗效和安全性。方法 :按照二线化疗方案将213例食管鳞癌患者分入4组:多西他赛组、紫杉醇组、吉西他滨组和伊立替康组。回顾性分析二线化疗的疗效和生存情况,应用log-rank检验和COX比例风险模型分别进行预后的单因素和多因素分析。结果 :多西他赛组、紫杉醇组、吉西他滨组和伊立替康组接受二线化疗的客观有效率分别为30.9%、25.0%、19.5%和11.4%(P=0.113),疾病控制率分别为56.7%、52.5%、51.2%和45.7%(P=0.721),中位无进展生存时间分别为3.0、2.1、2.7和1.5个月,中位生存时间分别为7.6、7.9、7.7和7.2个月。4组的无进展生存和总生存的差异均无统计学意义(P=0.240,P=0.094)。多因素分析结果显示,一线化疗疗效和美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)体能状况评分是二线化疗后无进展生存和总生存的独立影响因素(P值均<0.05)。结论 :含多西他赛、紫杉醇、吉西他滨或伊立替康的二线化疗方案治疗食管鳞癌可取得一定的疗效,且不良反应可以耐受。ECOG体能状况评分和一线化疗疗效是二线化疗后无进展生存和总生存的独立影响因素。
Objective: To investigate the efficacy and safety of different regimens of second-line chemotherapy in the treatment of esophageal squamous cell carcinoma. Methods: 213 patients with esophageal squamous cell carcinoma were divided into 4 groups according to second-line chemotherapy: docetaxel group, paclitaxel group, gemcitabine group and irinotecan group. The curative effect and survival of second-line chemotherapy were retrospectively analyzed. Single-factor and multivariate analysis of prognosis were performed by log-rank test and COX proportional hazard model respectively. RESULTS: The objective effective rates of second-line chemotherapy in docetaxel group, paclitaxel group, gemcitabine group and irinotecan group were 30.9%, 25.0%, 19.5% and 11.4%, respectively (P = 0.113), and the disease control rates were 56.7 %, 52.5%, 51.2% and 45.7% respectively (P = 0.721). The median progression-free survival time was 3.0, 2.1, 2.7 and 1.5 months respectively. The median survival time was 7.6, 7.9, 9.7 and 7.2 months respectively. There was no significant difference between progression-free survival and total survival in the 4 groups (P = 0.240, P = 0.094). Multivariate analysis showed that the efficacy of first-line chemotherapy and ECOP scores were independent predictors of progression-free survival and overall survival after second-line chemotherapy (all P <0.05). CONCLUSIONS: Second-line chemotherapy with docetaxel, paclitaxel, gemcitabine or irinotecan can achieve some therapeutic effects in patients with esophageal squamous cell carcinoma and the adverse reactions can be tolerated. ECOG performance status and first-line response to chemotherapy are independent predictors of progression-free survival and overall survival after second-line chemotherapy.