食管癌临床分期与病理分期分布合理性和预后判断价值比较

Comparison of rationality and prognostic value between clinical staging and pathological staging for esophageal cancer

目的 通过与术后病理分期标准的比较,探讨《非手术治疗食管癌的临床分期标准（草案）》的分布合理性及判断预后的价值.方法 回顾分析2009-2012年间本院根治手术或术后辅助治疗的162例食管癌患者临床资料,对其进行术前临床分期及术后病理分期,并采用Kappa法分析两种分期间各期病例分布一致性.Kaplan-Meier法计算OS率并Logrank法检验差异和单因素分析.结果 T、N、TNM分期总符合率分别为67.9％、57.4％、67.9％,一致性程度分别为中等、较差、中等（Kappa=0.544、0.302、0.509）.随访率为93.2％,1、2、3年样本数分别为127、66、27例.全组1、2、3年OS率分别为82.6％、56.2％、37.7％.术前除了T1与T2期、N0与N1期OS相近外（P=0.086、0.101）,T、N、TNM分期各期间OS均不同（P =0.000 ～0.028）,与术后病理分期对预后判断的预示作用一致.结论 《非手术治疗食管癌的临床分期标准（草案）》的分布合理性一般,预后判断价值较好,但仍需进一步细化和完善.

Objective To investigate the rationality and prognostic value of the Criteria for clinical staging of esophageal cancer treated by non-surgical methods （Draft） by comparison with the criteria for postoperative pathological staging.Methods A retrospective analysis was performed on the clinical data of 162 patients with esophageal cancer who underwent radical resection at the Second Hospital of Soochow University from December 2008 to July 2012.Preoperative clinical staging and postoperative pathological staging were performed,and the Kappa statistic was used to evaluate the agreement between the two staging systems.The Kaplan-Meier method was used to calculate overall survival （OS） rates,and the log-rank test was used for survival difference analysis and univariate analysis.Results The coincidence rates of T,N,and TNM stages were 67.9％,57.4％,and 67.9％,respectively,and the agreements were moderate,poor,and moderate,with Kappa values of 0.544,0.302,and 0.509.The follow-up rate was 93.2％.The 1-,2-,and 3-year sample sizes were 127,66 and 27,respectively.The 1-,2-,and 3-year OS rates were 82.6％,56.2％,and 37.7％,respectively.There were no significant differences in OS between patients with preoperative T1 and T2 stages and between patients with preoperative N0 and N1 stages （P =0.086,0.101）,but significant differences were observed between patients with different T stages,N stages,or TNM stages （P =0.000-0.028）.This was in line with the prognostic results based on the postoperative pathological staging.Conclusions The clinical staging criteria （draft） have moderate agreement with the criteria for postoperative pathological staging and have good prognostic value,but they require further refinement and improvement.