肿瘤体积在食管癌非手术治疗临床分期中的价值

The study of tumor volume in clinical staging of the non-surgical treatment esophageal carcinoma

目的 通过分析根治性放疗食管癌患者的原发瘤GTV体积及其对周围组织器官的外侵程度,探讨改进后的GTV体积分期标准对食管癌预后的预测价值.方法 回顾分析根治性放疗的食管癌患者701例,参考既往分期标准进行食管癌GTV体积临床分期,并结合预后进行分析,提出在T分期中除GTV体积大小外,还应参考原发瘤对周围组织器官的外侵程度进行降级分类,并按新标准重新评估预后生存,最后结合N0、N1、N2进行临床TNM分期.结果 全组患者按照既往GTV体积临床分期标准进行的T分期中,T3期与T4期的生存差异无统计学意义（P＞0.05）,临床TNM分期中Ⅲ期与Ⅳ期比较差异不明显（P＞0.05）.修改T分期标准、即在GTV体积分级基础上,同时考虑了原发瘤对周围组织器官的浸润程度,结果该T分期的生存曲线分离度好,各期间比较差异有统计学意义（χ^2=59.702,P＜0.05）;临床TNM分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期的5年生存率分别为33.5％、26.3％、13.4％、9.2％,各期比较差异有统计学意义（χ^2=82.577,P＜0.05）.结论 食管癌患者GTV体积与病变周围组织器官的受侵程度结合起来进行的新T分期标准的界定,能够比较准确地预测根治性放疗食管癌患者的预后生存.

Objective To explore the prediction value of the modified clinical staging standard of GTV volume on non-surgical treatment esophageal carcinoma by analyzing the GTV volume of esophageal carcinoma and the invasion degree of structures and surrounding organs as the T stage standard.Methods A retrospective analysis was performed for 701 esophageal cancer patients treated by definitive radiotherapy from Jan.2006 to Dec.2012.After grouping and analysis by the previous GTV volume staging standards, we put forward the idea that considering effects of invasion degree of structures and surrounding organs of tumor on the basis of GTV volume when it came to T stage, which would be re-classified by downgrading and reevaluation of survival and prognosis.Results There was no significant survival differences between T3 and T4 on previous GTV volume staging standards （P 〉 0.05）, and also had shown an inconspicuous survival difference between stage Ⅲ and stage Ⅳ when combined with three-group N stage（P 〉 0.05）.We had modified the T stage standards of GTV volume： Based on different size of GTV volume, and in consideration of the invasion of adjacent structures and organs, new T stages had shown good separation on a corresponding survival curve（χ^2=59.702 ,P 〈0.05）.In clinical TNM staging which combined with the new T stage and three-group N stages, the 701 patients were divided into stage Ⅰ , Ⅱ , Ⅲ and Ⅳ, with corresponding 5-year survival rates of 33.5% , 26.3% , 13.4% , 9.2% , respectively, which strongly revealing significant differences of survival rates （χ^2 =82.577, P 〈 0.05）.Conclusions The new T staging standard, which combined GTV volume with invasion degree of adjacent structures and organs, could accurately predict the prognosis of patients with radical radiotherapy of esophageal carcinoma.