| Objective Taxanes as a class of anti-tumour,has been widely used in esophageal malignant tumor in the first-line chemotherapy,the clinical commonly used yew now include four kinds:paclitaxel,dorsey his game,paclitaxel liposome and albumin in combination with paclitaxel,this study by comparing the four kinds of yew drugs combined platinum synchronous radiation therapy in esophageal cancer recent efficacy and safety of first-line treatment differences,and further analyzes the factors affecting the prognosis of esophageal cancer,explore the application value of different yew drugsMaterials and Methods The clinicopathological data of unresectable,newly diagnosed esophageal cancer patients admitted to the Oncology Department of Subei Hospital from October 1,2018 to May 31,2020 were collected.All patients received paclitaxel drugs(paclitaxel,docetaxel,paclitaxel liposome or albumin-bound paclitaxel)combined with platinum therapy in the first line,and radiotherapy during chemotherapy.Platinum drugs include cisplatin and nedaplatin;Radiotherapy was radical synchronous radiotherapy with a dose of 50-60Gy/25-30 times,1.8-2Gy/time,5 times/week.Efficacy was assessed every two cycles of chemotherapy according to RECIST1.1,safety was assessed per cycle according to NCI-CTC5.0,and acute radiotherapy side effects were assessed according to RTOG/EORTC.By chi-square Test and Fisher’s Exact Test used to compare different yew drug group of efficient and incidence of adverse reactions,by the method of Kaplan Meier-groups of progression-free surial Progression-free survival(PFS)and Overall survival(Overall survival,OS)is analyzed,and the factors affecting the prognosis of PFS and OS are single factor analysis and COX multiple factors analysis,follow-up deadline for the December 31,2020.Results 1.Basic clinicopathological features of the whole group of patients:A total of 143 newly diagnosed patients were collected in this study,including 112 males and 31 females,36 cases of upper thoracic esophageal cancer,61 cases of middle thoracic esophageal cancer,and 46 cases of lower thoracic esophageal cancer.There were 43 patients in the paclitaxel group,35 in the albumin-bound paclitaxel group,40 in the docetaxel group,and 25 in the paclitaxel liposome group.103 cases of nedaplatin and 40 cases of cisplatin;T staging was performed according to the draft clinical staging standard for non-surgical esophageal cancer,including 81 patients with T1-2 stage.62 patients with T3-4 stage;There were 63 cases of stage NO(without lymph node metastasis)and 80 cases of stage N1(with lymph node metastasis).2.Short-term therapeutic effect of different taxol drugs combined with platinum synchronous radiotherapy for first-line treatment of esophageal cancer.Taxol group The Objective response rate(ORR)and Disease control rate(DCR)were 53.4%and 97.6%respectively.ORR and DCR of albumin-bound paclitaxel group were 60.0%and 100%.ORR and DCR were 52.5%and 97.5%in docetaxel group.The ORR and DCR of paclitaxel liposome group were 48.0%and 88.0%respectively.ORR and DCR were the highest in the albumin-bound paclitaxel group,but statistical analysis showed that ORR and DCR were not significantly different among different taxanes in the four groups(ORR:P=0.909,DCR:P=0.099).3.Prognostic analysis of different taxanes combined with platinum synchronous radiotherapy for first-line treatment of esophageal cancer.The median PFS and median OS in the paclitaxel group were 9.3 months and 18.3 months respectively.In the albumin-bound paclitaxel group,the median PFS was 18.5 months and the median OS was not reached.The median PFS of docetaxel group was 11.0 months,and the median OS was not reached.In the paclitaxel liposome group,the median PFS was 8.9 months and the median OS was 14.4 months.Four groups of the median PFS generally have significant difference(P value is 0.030),which the median PFS albumin in combination with paclitaxel group is significantly higher than paclitaxel and paclitaxel liposome group,the difference was statistically difference(P value is 0.016,0.015),and albumin in combination with paclitaxel group median PFS and dorsey him between the groups was not significant difference(P value is 0.187).There was no significant difference in median OS among the four groups(P value is 0.092),and there was no significant difference in median OS between the albumin-bound paclitaxel group and the paclitaxel group,docetaxel group and paclitaxel liposome group(P value 0.279,0.902,0.125).4.Safety analysis of different taxoides combined with platinum synchronous radiotherapy for first-line treatment of esophageal cancer.This study analyzes the overall incidence of adverse events,four groups of four groups of white blood cells to reduce the incidence of no statistical difference(P=0.998),four groups of neutropenia was no statistical difference(P=0.963),the incidence of four groups of thrombocytopenia is no statistical difference(P=0.739),four groups of hemoglobin to reduce the incidence of no statistical difference(P=0.781),four groups of elevated ALT/AST no statistical difference(P=0.322),four groups of total bilirubin rise no statistical significance(P=0.218),There was no statistical difference in the incidence of radiation esophagitis among the four groups(P=0.456).No cases of nephrotoxicity were found in each group.The incidence of grade 3/4 hematotoxicity,hepatotoxicity and radioactive esophaditis in the four groups was further analyzed.The rates of grade 3/4 leukocytopenia in each group(paclitaxel,paclitaxel,docetaxel,paclitaxel liposomes,respectively)were 48.6%:37.2%,32.0%:50.0%,and there was no statistical difference between the four groups(P=0.605).The proportion of grade 3/4 neutropenia was 40.0%:37.2%;32.0%;47.5%,there was no statistical difference between the four groups(P=0.627);The proportion of 3/4 grade thrombocytopenia was 11.4%:4.7%:5.0%,0.0%,and there was no statistical difference among the four groups(P=0.327).The decrease rate of 3/4 grade hemoglobin was 2.9%:4.7%:15.0%:8.0%,and there was no statistical difference among the four groups(P=0.373).The rate of grade 3/4 radiation esophagitis was 8.5%:4.6%:2.5%:0.0%;There was no statistical difference among the four groups(P=0.473).In general,there was no significant difference in overall side effects and 3/4 grade side effects among the four groups.5.Cox analysis of influence on prognosis of esophageal cancer.Univariate analysis and multivariate Cox analysis were performed in 143 patients with different gender,age,tumor location,platinum type,taxo type,T stage and N stage.RESULTS:Different taxanes and N stage significantly affected patients’PFS.Multivariate Cox analysis showed that N stage was an independent factor affecting patients’ PFS.Different taxanes,T stage and N stage had significant effects on patients’ OS.Multivariate Cox analysis showed that T stage and N stage were independent factors affecting patients’ OS.Conclusion Nab-paclitaxel plus platinum synchronous radiation first-line treatment the curative effect of esophageal cancer than other yew drugs(paclitaxel,dorsey,paclitaxel liposome)there is a certain advantage,PFS than other yew drugs significantly extended,side effects similar to other yew drugs,conclusion can be used as a first-line chemoradiation chemotherapy drugs,clinical need to be further validated large sample,prospective study. |
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