非手术治疗胸段食管癌临床分期与预后关系的初步探讨

Preliminary study of clinical staging of moderately advanced and advanced thoracic esophageal carcinoma treated by non surgical methods

目的探讨非手术治疗胸段食管癌临床分期与预后的相关性,为放射+化疗的综合治疗方案的选择提供参考标准。方法对单纯放射治疗的500例中晚期胸段食管癌进行回顾性分析。根据食管钡餐X线片病变长度、CT外侵程度以及病变与周围组织器官的关系,将病变局部分为T1、T2a、T2b、T3a、T3b、T4期,并结合区域淋巴结转移对应临床分期进行Ⅰ、Ⅱa、Ⅱb、Ⅲa、Ⅲb、Ⅳ期六分类法和Ⅰ、Ⅱ、Ⅲ、Ⅳ期四分类法分期,观察不同分期下的生存情况。结果500例中T1、T2a、T2b、T3a、T3b、T4期分别为23、111、157、84、82、43例,其5年内生存率曲线比较差异有显著性意义(χ2=63.52,P<0.05)。T2a与T2b、T3a与T3b期合并后T1、T2、T3、T4期分别为23、268、166、43例,其5年内生存率曲线比较差异有显著性意义(χ2=56.29,P<0.05)。六分类法的Ⅰ、Ⅱa、Ⅱb、Ⅲa、Ⅲb、Ⅳ期分别为21、96、139、89、87、68例,其5年内生存率曲线比较差异有显著性意义(χ2=94.29,P<0.05)。四分类法的Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为21、235、176、68例,其5年内生存率曲线比较差异有显著性意义(χ2=83.48,P<0.05)。结论中晚期食管癌临床分期的六分类法和四分类法均能较好地预示食管癌放射治疗的预后,为临床应用方便,建议使用四分类法。

Objective To explore the clinical staging of moderately advanced and advanced thoracic esophageal carcinoma by evaluating the prognosis and provide criteria for individual treatment. Methods We retrospectively analyzed 500 patients with moderately advanced and advanced thoracic esophageal carcinoma treated by radiotherapy alone. According to the primary lesion length by barium meal X ray film, the invasion range and the relation between location and the surrounding organs by CT scans the disease category was classified by a 6 stage method and a 4 stage method. With the primary lesion divide into T1,T2a,T2b,T3a,T3b and T4 incorporating the loc regional lymph node metastasis, a 6 stage system was obtained, Ⅰ,Ⅱa, Ⅱb,Ⅲa, Ⅲb and Ⅳ. The results of this as compared with those of 4 stage system, the following data were finally arrived at. Results Among the 500 cases, there were T1 23, T2a 111,T2b 157,T3a 84,T3b 82 and T4 43. The survival rates of these six categories showed significant differences(χ 2=63.32,P<0.05).With T2a T2b and T3a T3b combined there were T1 23,T2 268,T3 166 and T4 43.The respective survival rates also showed significant differences(χ 2=56.29,P<0.05).By the 6 stage method, there were Ⅰ 21,Ⅱa 96, Ⅱb 139,Ⅲa 89, Ⅲb 87 and Ⅳ 68. Their respective survival rates showed significant differences(χ 2=94.29,P<0.05). By the 4 stage method, there were Ⅰ21,Ⅱ235, Ⅲ 176 and Ⅳ 68. Their respective 5 year survival rates showed significant differences(χ 2=83.48,P<0.05). Conclusions Both the 6 stage and 4 stage systems are adaptable to predict prognosis of moderately advanced and advanced esophageal carcinoma treated by radiotherapy alone. For simplicity and convenience, the 4 stage classification is recommended.