食管腔内超声参与的非手术食管癌临床分期与预后的相关性研究

Clinical staging of non-surgically treated esophageal cancer based on EUS and CT and its prognostic value

目的 探讨有腔内超声（EUS）参与的非手术食管癌临床分期的实用性以及对预后的预测价值.方法 搜集本院2003-2012年间非手术治疗的290例食管鳞癌患者资料.结合EUS、CT检查按2002年UICC分期标准对全组患者进行临床分期,并分析各期别间患者的生存率及预后因素.Kaplan-Meier法计算生存率并Logrank检验,采用Cox法进行多因素分析.结果 EUS完全通过并能有效T、N分期者178例,其中T1～T4期的OS差异无统计学意义（P =0.247）,N0期的OS、PFS差异均有统计学意义（P=0.000、0.006）,N0与N1期的OS、PFS差异也均有统计学意义（P=0.012、0.016）.EUS不能通过者112例,较能通过者的OS、PFS差（P=0.001、0.003）.CT的T分期和N分期对OS、PFS均有影响（P=0.004、0.030和P=0.024、0.020）.全组1、3、5年样本数分别为290、174、73例,全组1、3、5年OS分别为61.7％、27.8％、19.8％.2002 UICC临床分期各期别间OS、PFS差异均有统计学意义（P =0.000、0.000）.多因素分析显示性别、年龄、临床分期是总生存的影响因素（P =0.004、0.020、0.002）.结论 有EUS参与的食管癌临床分期能预测非手术治疗患者的预后,建议将EUS作为我国食管癌疗前分期检查的基本手段.

Objective To investigate the clinical staging of non-surgically treated esophageal cancer based on endoscopic ultrasonography （EUS） and computed tomography （CT） and its prognostic value. Methods A total of 290 patients with esophageal squamous cell carcinoma who received non-surgical treatment in our hospital from November 2003 to March 2012 were retrospectively reviewed. The clinical stage of each patient was evaluated based on EUS and CT according to the 2002 UICC TNM staging system. The survival rates and prognostic factors for patients of different stages were analyzed. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis; the multivariate analysis was performed using the Cox model. Results EUS could be completely performed in 178（61.4% ） of all patients, and their EUS T and N stages were determined. There were no significant differences in overall survival （OS） between patients with EUS T1 -T4 diseases （ P = 0. 247 ） ; there were significant differences in OS and progression-free survival （PFS） between individuals of different EUS T stages among patients with EUS No disease （ P = O. 000 ; P = 0. 006）. OS and PFS also showed significant differences between patients with No and N1 diseases （P =0. 012;P =0. 016）. EUS could not be completely performed in 112 patients, who had poorer OS and PFS than other patients （P =0. 001 ;P =0. 003）. CT T and N stages also affected OS and PFS （ OS P = 0. 004, PFS P = 0. 030 ; OS P = 0. 024, PFS P = 0. 020）. The 1-, 3-, and 5-year sample sizes were 290, 174, and 73, respectively. The 1-, 3-, and 5-year OS rates for all patients were 61.7%, 27. 8%, and 19. 8%, respectively. OS and PFS varied significantly between patients of different 2002 UICC clinical stages （ P =0. 000 and 0. 000）. The multivariate analysis showed that sex, age and clinical stage were independent prognostic factors （ P = 0. 004, O. 020, and 0. 002 ）. Conclusions The clinical staging based on EUS and CT can predict the survival in esophageal cancerpatients treated with non-surgical method. EUS is recommended as a basic means for pretreatment staging of esophageal cancer in China.