食管狭窄与食管癌放化疗远期预后的关联及预测模型构建

Association between esophageal stenosis and long-term prognosis of esophageal cancer after chemoradiotherapy and construction of a prediction model

摘要

目的：探讨食管狭窄与食管癌放化疗远期预后的关联，并构建食管癌放化疗后食管狭窄的预测模型。方法：选取2021年1月~2025年1月于安徽省胸科医院肿瘤放疗科进行放化疗治疗的100例食管癌患者为研究对象，根据放化疗后是否发生食管狭窄将患者分成狭窄组、未狭窄组。对所有患者进行1年随访，采用Kaplan-Meier法计算对比两组的总生存率（OS）和无进展生存率（PFS）。收集两组患者的临床资料，单因素、多因素Logistic回归分析食管癌患者放化疗后食管狭窄的影响因素，并利用R软件构建食管癌放化疗后食管狭窄的预测模型。结果：100例食管癌患者中27例放化疗后发生食管狭窄，发生率为27.00%。Kaplan-Meier法结果显示，狭窄组的OS、PFS均低于未狭窄组（P<0.05）。单因素结果显示，狭窄组、未狭窄组的组织浸润深度、临床分期、T分期、肿瘤侵犯食管全周的比例（周在性）、固有肌层受损、病变长度、病变范围、放疗剂量对比，差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，组织浸润深度、T分期、周在性、固有肌层受损、病变长度、放疗剂量等均是食管癌患者放化疗后食管狭窄的独立影响因素（P<0.05）。基于Logistic回归分析建立预测模型，模型验证结果显示，该列线图模型的一致性指数为0.853（95% CI：0.820~0.915）。结论：食管狭窄与食管癌放化疗的远期预后密切相关，多种因素与食管癌放化疗后食管狭窄有关，构建预测模型对食管癌放化疗后食管狭窄具有良好的预测价值。

Abstract

Objective To investigate the association between esophageal stenosis and long-term prognosis of esophageal cancer after chemoradiotherapy, and to construct a prediction model for post-chemoradiotherapy esophageal stenosis. Methods A total of 100 esophageal cancer patients who underwent chemoradiotherapy at the Department of Radiation Oncology, Anhui Chest Hospital between January 2021 and January 2025 were selected as the study subjects, and they were divided into a stenosis group and a non-stenosis group based on the occurrence of post-chemoradiotherapy esophageal stenosis. All patients were followed up for 1 year, and Kaplan-Meier analysis was used to compare overall survival (OS) and progression-free survival (PFS) between the two groups. Clinical data of the two groups were collected. The influencing factors of post-chemoradiotherapy esophageal stenosis in esophageal cancer patients were identified using univariate and multivariate Logistic regression analyses, and a prediction model of post-chemoradiotherapy esophageal stenosis was constructed using R software. Results Esophageal stenosis occurred in 27 of 100 patients with esophageal cancer after chemoradiotherapy, with an incidence rate of 27.00%. The results of the Kaplan-Meier method showed that OS and PFS were lower in the stenosis group than in the non-stenosis group (P<0.05). Univariate analysis revealed statistically significant differences in the depth of tissue infiltration, clinical stage, T stage, circumferential involvement, intrinsic muscle layer damage, lesion length, lesion extent, and radiotherapy dose between the stenosis group and the non-stenosis group (P<0.05). Multivariate Logistic regression analysis identified the depth of tissue infiltration, T stage, circumferential involvement, intrinsic muscular layer damage, lesion length, and radiotherapy dose were independent influencing factors of esophageal stenosis after radiotherapy in patients with esophageal cancer (P<0.05). A prediction model was established based on Logistic regression analyses, and the model validation results showed that the established nomogram model achieved a consistency index of 0.853 (95% CI: 0.820-0.915). Conclusion Esophageal stenosis is closely related to the long-term prognosis of chemoradiotherapy for esophageal cancer, and a variety of factors are associated with post-chemoradiotherapy esophageal stenosis. The constructed prediction model exhibits flavorable predictive performance for esophageal stenosis after chemoradiotherapy in esophageal cancer patients.

关键词

食管狭窄 / 食管癌 / 放化疗 / 远期预后 / 预测模型

Key words

esophageal stenosis / esophageal cancer / chemoradiotherapy / long-term prognosis / prediction model

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基金资助

安徽省卫生健康科研项目(AHWJ2023A20456)