| Objective: To compare the efficacy and safety of paclitaxel and fluorouracil combined with cisplatin in concurrent chemoradiotherapy for locally advanced esophageal squamous cell carcinoma.Methods: The clinical data of 349 patients with esophageal squamous cell carcinoma who were treated with concurrent chemoradiotherapy from January 2005 to December 2015 in our hospital was retrospectively analysed.These patients were divided into fluorouracil plus cisplatin(FP)group of 295 cases and paclitaxel plus cisplatin(TP)group of 54 cases,propensity score matching method was used to balance the confounding factors.The Kaplan-Meier method and Log-rank test were used to calculate local control,overall survival and progress-free survival rates.Univariate and multivariate prognostic analyses were performed by Cox model.Results:1.With a total of 349 patients,there was no significant difference in the short-term efficacy between FP and TP groups(P=0.341).The 1-,3-,5-year local control rates were 73.2%,43.4%,34.8% in the FP group and 70.4%,50.0%,42.2% in the TP group(P=0.568).The 1-,3-,5-year overall survival rates were 76.3%,44.8%,35.5% in the FP group and 77.8%,51.9%,42.2% in the TP group(P=0.579).The progress-free survival rates were 66.9%,40.4%,34.0% in the FP group and 64.6%,48.9%,40.9% in the TP group(P=0.705).2.With a total of 147 patients after propensity score matching,there was no significant difference in the short-term efficacy between FP and TP groups(P=0.370).The 1-,3-,5-year local control rates were 70.5%,36.8%,30.1% in the FP group and 71.2%,50.0%,41.9% in the TP group(P=0.295).The 1-,3-,5-year overall survival rates were 73.7%,40.0%,30.3% in the FP group and 78.9%,51.9%,41.9% in the TP group(P=0.326).The progress-free survival rates were 66.0%,33.8%,29.1% in the FP group and 65.1%,48.9%,40.5% in the TP group(P=0.337).In terms of toxicity and side effects,the TP group had a higher incidence of radiation esophagitis(P=0.005)and thrombocytopenia(P=0.040),while the FP group had a higher incidence of leukopenia(P=0.011).Multivariate analysis showed that non-operative N staging(P=0.044)and consolidation chemotherapy(P=0.034)were independent prognostic factors affecting survival.At the end of the follow-up,147 cases dead and there was no significant difference in cause analysis between the two groups(P=0.083).3.The 1-,3-,5-year local control rates and overall survival rates of patients with consolidation chemotherapy and those without were 76.6%,46.8%,37.0% and 60.4%,32.1%,28.2%(P=0.035),79.8%,50.0%,36.8% and 67.9%,34.0%,28.2%(P=0.016).In terms of toxicity and side effects,the difference between the two groups was not statistically significant(P>0.05),but there were cases of severe radiation pneumonia(1.1%),radiation esophagitis(3.2%),leukopenia(10.7%),hemoglobin reduction(2.1%)and thrombocytopenia(3.2%)in the consolidation chemotherapy group,which should be vigilant.Conclusions:1.In concurrent chemoradiotherapy for patients with esophageal squamous cell carcinoma,FP and TP showed no significant difference in short-term efficacy,local control,overall survival and progression-free survival,but the median survival time of TP were all have a tendency to prolong.In terms of toxicity and side effects,TP had a higher incidence of radiation esophagitis and thrombocytopenia compared with FP,but the severity was lower,while FP had a higher incidence of leukopenia.Prognostic multivariate analysis showed that lower non-operative N stage and consolidation chemotherapy were both survival benefit factors.2.There was no significant difference in cause of death analysis between the two groups,with local tumor recurrence and distant metastasis dominating.3.Consolidation chemotherapy has a significant advantage in local control rate and overall survival rate compared with patients without consolidation chemotherapy,with no significant increase in toxicity and side effects,but there were cases of severe radiation pneumonia,esophagitis and bone marrow suppression,which need to be noted. |
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