食管癌IMRT中肿瘤及转移淋巴结大小对预后影响分析

Effects of gross tumor volume and positive lymph node volume on prognosis of intensity-modulated radiotherapy for esophageal squamous cell carcinoma

目的 探讨GTV-T及GTV-LN对根治性同步放化疗食管鳞癌患者预后影响。方法 对肿瘤医院2012—2015年行根治性放疗的79例N1期食管鳞癌患者被纳入研究。利用Pinnacle3 9.0TPS计算GTV-T及GTV-LN,通过ROC评价GTV-LN/GTV-T在食管鳞癌的LR及DM预测中价值。结果 全组中位随访时间17.2个月。以GTV-LN/GTV-T测定值绘制ROC曲线,LR患者最佳诊断值为0.34,DM患者最佳诊断值为0.59。统计分析显示GTV-LN/GTV-T〈0.34和≥0.34患者LR分别为50%和8%（P〈0.01）;GTV-LN/GTV-T〈0.59和≥0.59患者DM分别为11%和43%（P=0.003）。结论 GTV-LN/GTV-T或许能预测食管鳞癌患者LR及DM,关于GTV-LN/GTV-T进一步研究或许可以帮助食管鳞癌个体放化疗方案的选择。

Objective To analyze the effects of gross tumor volume （GTV-T） and positive lymph node volume （GTV-LN） on the prognosis of radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma （ESCC）. Methods A total of 79 patients with stage N1 ESCC undergoing radical radiotherapy in our hospital from 2012 to 2015 were enrolled as subjects. GTV-T and GTV-LN were calculated by the Pinnacle3 9.0 treatment planning system. The receiver operating characteristic （ROC） curves were used to evaluate the value of the GTV-LN/GTV-T ratio in the prediction of local recurrence （LR） and distant metastasis （DM） of ESCC. Results The median follow-up time was 17.2 months in all patients. The ROC curves were made using the GTV-LN/GTV-T ratio. The optimal cut-off values of GTV-LN/GTV-T ratio for predicting the risk of LR and DM were 0.34 and 0.59, respectively. The statistical analysis revealed that the LR rates were 50% and 8% in patients with GTV-LN/GTV-T ratios of〈0.34 and ≥0.34, respectively （P〈0.01）, while the DM rates were 11% and 43% in patients with GTV-LN/GTV-T ratios of〈0.59 and ≥0.59, respectively （P=0.003）. Conclusions The GTV-LN/GTV-T ratio may be a predictor of LR and DM in patients with ESCC. Further studies on the GTV-LN/GTV-T ratio may help to make personalized chemoradiotherapy strategies for patients with ESCC.