非手术治疗食管癌临床分期标准对225例放疗患者的预后评价

Evaluation of prognosis of clinical staging for esophageal carcinoma treated with non-surgicalmethods--addition with analysis of 225 patients

目的参考中国非手术治疗食管癌临床分期专家小组制定的“非手术治疗食管癌临床分期”修改方案对225例食管癌三维适形放疗患者进行预后分析与评价，探讨此分期的实用性及对食管癌非手术治疗预后的预测价值。方法2001--2007年间225例食管癌患者接受三维适形放疗，全组处方剂量5000—7000cGy，中位数6400coy。25例患者在常规分割照射3000～4000cGy后改用后程加速照射，300cGy／次；余患者均采用常规分割照射180～200cGy／次，5次／周。57例患者接受了同期巩固化疗。依据临床分期标准将患者分为各T、N期及TNM期亚组，观察其局部控制率、生存率，并进行预后因素分析。结果随访率为99．6％，随访满3、5年者分别为116、33例。全组1、3、5年局部控制率分别为77．2％、48．2％、34．5％，生存率分别为68．4％、33．7％、20．8％，中位生存期20个月。T1～T4期间、N0～N2期间及TNMI～Ⅲ期患者间生存情况不同（X^2=13．07、20．49、17．16，P=0．004、0．000、0．000）。I、Ⅱ和Ⅲ期患者1、3、5年生存率分别为89．4％、56．1％、37．8％，69．6％、32．4％、18．0％和47．2％、19．5％、13．0％。Cox回归模型多因素分析结果显示肿瘤CT长度，临床N分期、近期疗效是独立预后因素。结论“非手术治疗食管癌临床分期”修改方案能够较为准确地反应食管癌放疗患者的预后情况，临床N分期与预后的关系可能更为紧密。分期修改方案细节之处有待进一步完善。

Objective To analyze the prognosis of 225 patients according with clinical staging of esophageal carcinoma treated with non-surgical methods, and investigate the practicality and predictive value of the clinical staging. Methods From March 2001 to July 2007, 225 patients with esophageal carcinoma received 3DCRT treatment. The prescribed doses were ranged from 5000 -7000 cGy with the median dose of 6400 cGy, 25 patients received accelerative radiation of 300 cGy per fraction after conventional radiotherapy of 3000 -4000 cGy, 57 patients received concurrent chemotherapy with or without consolidation chemotherapy. All the patients were divided into subgroups of different T stages, different N stages and different TNM stages. Local control rates, survival rates were observed and Cox regression analysis were performed to search valuable prognostic factors. Results The following-up rate was 99. 6%. The 3-and 5- years following-up number were 116 and 33 patients, respectively. The 1- ,3-, and 5-year local control rates were 77.2% ,48.2% and 34.5% , respectively. The 1-,3-,and 5-year overall survival rates were 68. 4% , 33.7% and 20. 8%, respectively. The median survival time was 20 months. There were significant difference between survival curves for T1-4 stages, N0_2 stages and I - m stages with X^2 value of 13.07, 20. 49 and 17.16, with P value of 0. 004,0. 000 and 0. 000, respectively. For the group of stage I , II and 111, the 1-,3-, and 5-year survival rates were 89. 4% ,56. 1%, and 37.8% ;69.6% ,32. 4%, and 18.0% and 47.2%, 19.5%, and 13.0%, respectively. According to the result of Cox regression analysis, the tumor length of CT scan, clinical N stage, short term result were most valuable predictive factors. Conclusions The clinical staging of esophageal carcinoma treated with non-surgical methods could predict the prognosis accurately, clinical N stage may have more closely association with prognosis, however, some details of the staging program need more consummate.