食管癌患者肿瘤体积对T分期及预后的影响分析

Effect of Tumor Volume and Pathological T Staging on Prognosis of Esophageal Carcinoma

目的探讨食管癌患者大体肿瘤体积（gross tumor volume,GTV）对T分期及预后的影响。方法收集198例行根治性切除治疗的食管癌患者的临床资料,观察不同GTV分级的病理T分期分布情况、5年生存情况以及局部区域复发率和远处转移率。结果 GTV分级与T分期总符合率为72.16%,一致性分析显示两者存在一致性（Kappa=0.402,P〈0.01）。随着GTV分级升高T分期逐渐增加,且相邻T分期GTV分布有重叠现象;随着GTV分级升高食管癌患者整体生存率呈逐渐下降趋势,差异具有统计学意义（χ~2=21.900,P=0.000）。GTVⅠ级组和Ⅱ级组1、3、5年生存率及平均生存时间均显著高于GTVⅢ级组,差异具有统计学意义（P〈0.05）。随着GTV分级升高食管癌患者整体局部区域复发率先下降后升高,差异具有统计学意义（χ~2=7.58,P=0.023）;随着GTV分级升高食管癌患者整体远处转移率呈现逐渐升高趋势,但差异无统计学意义（χ~2=0.579,P=0.797）。结论随着食管癌患者GTV增大T分期逐渐增加,5年生存率逐渐下降,局部复发率和远处转移率逐渐增加。

Objective To explore the effect of gross tumor volume（ GTV） and pathological T staging on prognosis of esophageal carcinoma. Methods 198 cases of patients with esophageal cancer were treated by radical resection. The pathological T staging,5-year survival,recurrence rate,and distant metastasis rate in different GTV classification were observed. Results The total consistent rate of GTV classification and pathological T staging was 72. 16%,there with consistency between them（ Kappa =0. 402,P〈0. 01）; The T staging gradually increased with GTV classification,adjacent T staging GTV distribution had overlap phenomenon; The overall survival rate was reduced with the increase of GTV classification（ χ~2= 21. 900,P = 0. 000）; The 1-,3-,5-year survival rates of GTV Ⅰ and Ⅱ and mean survival time were higher than GTV Ⅲ（ P〈0. 05）; The recurrence rate of overall local area reduced and then increased as GTV staging increased（ χ~2= 7. 58,P = 0. 023）; There was no significant difference in the distant metastasis rate（ χ~2= 0. 579,P = 0. 797）; The distant metastasis rate of GTV Ⅱ was lower than that of GTV Ⅲ（ P〈0. 05）. Conclusion The pathological T staging increases as GTV increases in patients with esophageal cancer,the 5-year survival rate reduces,local recurrence and distant metastasis rates increase.