临床分期对根治性放疗食管癌患者预后的影响

Effect of clinical staging on the prognosis of patients with esophageal carcinoma receiving radical radiation therapy

目的:非手术治疗食管癌患者分别按照2004、2009年版临床分期标准分期,观察不同分期标准的各期食管癌患者的预后生存,以及大体肿瘤体积(gross tumor volume,GTV-T)对临床T分期及预后的影响,以期确定更为合理的食管癌临床分期标准。方法:回顾性分析219例行根治性放疗的食管癌患者的临床资料。患者于放疗前行食管钡餐造影检查、定位CT扫描并于放射治疗计划系统勾画靶区计算GTV-T。所有患者分别按照2004、2009年版临床分期标准进行分期,结合GTV-T,观察患者预后。结果:全组患者1、3、5年生存率分别为70.8%、35.6%、20.7%,中位生存期23个月。两种食管癌临床分期标准均能反映食管癌放疗预后,2009年版分期生存曲线分离度最好,生存差异具有显著性意义(χ2=29.497,P<0.001)。临床T分期与GTV-T大小呈正相关(r=0.615,P<0.001)。不同临床T分期中,GTV-T对患者预后有一定影响。结论:不同食管癌临床分期标准均能反映患者预后,2009版分期标准更佳。GTV-T与临床T分期呈正相关,反映预后。

This study aims to determine a reasonable clinical staging standard for patients with esophageal carcinoma who were receiving non-surgical treatment. The patients were staged on the basis of the （2004 and 2009 editions of clinical staging standards. The prognosis of patients with different staging standards, as well as the effect of gross tumor volume-tumor （GTV-T） on clinical T stage and prognosis, was observed. Methods：Data on 219 patients with esophageal carcinoma who were receiving radical radiotherapy were retrospectively analyzed. Prior to radiotherapy, all patients underwent examinations, including esophageal barium meal and positioning CT scan, for use in the radiation treatment planning system to outline the target range and to calculate the volume of GTV-T. All patients were staged with the use of the aforementioned clinical staging standards. Prognostic outcomes of the patients were observed. Results：For all patients, the one-, three-, and five-year overall survival rates were 70.8%, 35.6%, and 20.7%, respectively. The survival curve resolution of patients who were staged with the use of the 2009 edition of clinical staging standards was better than that of the patients who were staged with the use of the 2004 edition. Survival difference was significant （χ2=29.497, P〈0.001）. The clinical T stage positively correlated with GTV-T （r=0.615, P〈0.001）. GTV-T could thus affect prognosis at different T stages. Conclusion：Both esophageal carcinoma clinical staging standards could reflect the prognosis of patients undergoing radiotherapy, but the 2009 edition appeared more accurate than the 2004 edition.