非手术治疗食管癌临床分期标准(草案)的适用性分析

Analysis on the Applicability of the Non-surgical Clinical Staging for Esophageal Carcinoma

目的对《非手术治疗食管癌临床分期标准(草案)》(下称草案)进行分析,评价其合理性和适用性。方法回顾性分析2006年1月至2010年12月北京军区总医院和河北医科大学第四医院放疗科收治的胸段食管癌患者199例,依据草案对所有病例进行TNM分期,比较T、N、临床分期与预后的相关性。结果验证部分:患者的5年生存率,在T1、T2、T3、T4期分别为52.9%、42.7%、25.0%、21.6%;在N0、N1、N2期分别为41.2%、29.6%、20.8%,N0与N1期、N0与N2期比较差异均有统计学意义(P<0.05),但N1与N2期的差异无统计学意义(P>0.05);Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为83.7%、29.9%、23.7%和25.0%。修饰部分:N0、N+淋巴结转移分别为41.2%和28.1%。以N0和N+分期:Ⅰ、Ⅱ、Ⅲ、Ⅳ期的5年生存率分别为85.7%、31.0%、25.7%、20.0%;锁骨上淋巴结分别归为M1和N,N0、N+期生存方面的差异均有统计学意义(P<0.05)。结论草案对食管癌的T分期适用,但草案N分期不能很好地反映预后,建议在没有大样本病例能够对淋巴结细分的情况下将N分期分为无和有淋巴结转移。

Objective To analyze the non-surgical clinical staging for esophageal carcinoma, and to evaluate the rationality and practicality. Methods From Jan. 2005 to Dec. 2010,199 cases of esophageal carcinoma were treated with radical radiotherapy. All patients were staged according to the non-surgical clinical staging for esophageal carcinoma. The correlation between the staging and survival rate was analyzed. Results Verification section：the 5-year overall survival rate in patients at T1 , T2 , T3 and T4 was 52.9%, 42.7 %, 25.0%, 21.6 % respectively. The survival rates of No, N1 and N2 were 41.2 %, 29.6%, 20.8 %, where significant difference was shown between No and N1 , NO and N2 , while no significant difference was shown between N1 and N2;the 5-year overall survival rate in patients at Ⅰ , Ⅱ, Ⅲ and Ⅳ was 83.7%, 29.9% ,23.7% and 25.0% respectively. Modification parts：N0 and N ＋ lymph nodes metastasis rates were 41.2% and 28.1% ; the 5-year overall survival rate in patients of stage Ⅰ , Ⅱ , Ⅲ and Ⅳ was 85.7%, 31.0% ,25.7% ,20.0%. Whatever supraclavicular lymph nodes were classified into distant metastasis M1 or regional lymph nodes N,the 5-year survival rates of NO and N ＋ showed significant differences. Conclusion The protocol is applicable to T staging, but N staging cannot well reflect prognosis. It＇s suggested that in the absence of the bulk of cases,it＇s better to only classify the lymph nodes into No and N ＋ stage.