Objective: To investigate the association between the time of neutrophils to the lowest and prognosis of patients with esophageal squamous cell carcinoma (ESCC) treated with non-operative therapy. Methods: The clinical data of 325 non-operative treated ESCC patients were collected in this study. The X-title software was applied to establish optimal threshold of neutrophil reduction to the lowest value. According to the optimal threshold, the patients were divided into early group (115 cases) and late group (210 cases). The clinical features and survival time of the two groups were compared, and the factors of prognosis were analyzed by Cox regression model with univariate and multivariate analysis. Results: The X-title software demonstrated the optimal cutoff values for the time of neutrophils to the lowest was 39 days. The median overall survival time was 21.0 months in the early group which was significantly higher than that in the late group (16.0 months). Multivariate Cox regression analysis showed that the treatment methods and the time of neutrophils to the lowest were independent factors for overall survival of patients with ESCC treated by non-surgical therapy. Compared with radiotherapy alone, concurrent chemoradiation could benefit the survival (HR=0.64, P=0.026). The prognosis of patients in the late group of neutrophils to the lowest (HR=1.38, P=0.038) was poor compared with the early group. Furthermore, stratified by treatment methods, the overall survival of two groups showed statistically significant difference only in patients received concurrent chemoradiation. The mortality risk in the late group was higher than that in the early group (HR=3.53, P=0.010). Conclusion: The time of neutrophils to the lowest is an independent prognosis factor for non-operative treated ESCC patients. The prognosis of patients in the early group is better than that in the late group.
目的： 探讨中性粒细胞减少至最低值时间与非手术治疗食管鳞癌患者预后的关系。 方法： 收集325例非手术治疗食管鳞癌患者的临床资料，使用X－tile软件确定中性粒细胞减少至最低值时间的最佳界值，根据此最佳界值将患者分为早期组(115例)和晚期组(210例)。比较两组患者的临床特征和生存时间，患者预后的影响因素分析采用Cox回归模型单因素和多因素分析。 结果： 中性粒细胞减少至最低值时间的最佳界值为39 d。早期组中位生存时间为21.0个月，明显高于晚期组(16.0个月)。多因素Cox回归分析结果显示，治疗方式、中性粒细胞减少至最低值时间是非手术治疗食管鳞癌患者总生存的独立影响因素，相对于单纯放疗，同期放化疗更能使食管鳞癌患者生存获益(HR＝0.64，P＝0.026)，而中性粒细胞减少至最低值晚期组(HR＝1.38，P＝0.038)的患者预后差。按治疗方式分层分析显示，中性粒细胞减少至最低值时间只在同期放化疗层中显示与患者预后有关，晚期组患者的死亡风险要高于早期组患者(HR＝3.53，P＝0.010)。 结论： 中性粒细胞减少至最低值时间是影响非手术放化疗食管鳞癌患者的独立预后因素，中性粒细胞减少至最低值早的患者预后优于晚的患者。.
Keywords: Esophageal neoplasms; Neutropenia; Non-operative treatment; Prognosis; Squamous cel1 carcinoma.