窄带成像技术评价食管癌放疗的近期疗效

Narrow band imaging for the evaluation of short-term effect of radiotherapy on esophageal carcinoma

目的食管癌放射治疗的近期疗效评价尚缺乏统一标准。文中旨在探讨窄带成像技术(NBI)在食管癌放疗近期疗效评价中的价值。方法选取2013年12月至2016年12月江阴市人民医院肿瘤科初治食管鳞癌86例患者。于放疗前后均行NBI、食管钡餐造影和CT检查。比较普通电子胃镜和NBI 2种内镜下食管病变轮廓清晰度的差异;比较放疗后传统疗效评价(基于食管钡餐及CT)和新标准疗效评价(在传统疗效评价基础上增加NBI分级)的一致性;放疗前不同NBI分级对预后的影响。Cox风险回归模型进行多因素预后分析。结果 NBI内镜观察食管癌病灶轮廓清晰度总得分(249分)明显高于普通电子胃镜清晰度总得分(195分),差异有统计学意义(P<0.05)。传统疗效评价与新标准疗效评价标准对食管癌放疗疗效评价具有极强的一致性(Kappa=0.772,P=0.000)。Ⅲ级+Ⅳ级患者与Ⅰ级+Ⅱ级患者3年OS、PFS比较差异有统计学意义(P<0.05)。临床分期(HR=1.63,95%CI:1.14~2.66)和NBI分级(HR=1.42,95%CI:1.13~1.72)是影响3年OS的预后因素(P<0.05),亦是影响3年PFS的预后因素(P<0.05)。结论 NBI在清晰度上较普通电子胃镜食管癌病灶轮廓有一定的优势,NBI分级对预测食管癌疗效具有显著意义。联合食管钡餐造影和CT检查可有效评价对食管癌放疗近期疗效。

Objective The purpose of this study was to investigate the value of narrow band imaging（NBI） in evaluating the short-term effect of radiotherapy on esophageal carcinoma. Methods This study included 86 patients with esophageal squamous carcinoma treated in the Department of Oncology of Jiangyin People＇s Hospital from December 2013 to December 2016. All the patients underwent NBI,barium meal examination（BME） and CT scanning before and after radiotherapy. We compared the lesion contour sharpness shown by conventional endoscopy with that by NBI,analyzed the consistency between the two standards in evaluating the short-term effect of radiotherapy,and assessed the influence of NBI-based lesion grades on the prognosis of esophageal carcinoma,followed by a multivariate regression analysis of the prognostic factors with a Cox model. Results The total score on the lesion contour sharpness by NBI was significantly higher than that by conventional endoscopy（249 vs 195,P〈0.05）,and a significant consistency was found between the two standards in evaluating the short-term effect of radiotherapy（Kappa = 0.772,P = 0.000）. Both the 3-year overall survival and 3-year progress-free survival rates were remarkably higher in the patients with NBI-based grades Ⅲ＋Ⅳ than in those with grades Ⅰ＋Ⅱ lesion（71.9% vs 37.5%,P〈0.05; 58.1% vs 24.9%,P〈0.05）. Clinical stages（HR = 1.63,95% CI： 1.14-2.66）and NBI-based lesion grades（HR = 1.42,95% CI： 1.13-1.72） were independent prognostic factors for both the 3-year overall survival（P〈0. 05） and 3-year progress-free survival（P〈0. 05） of the esophageal carcinoma patients. Conclusion NBI presents a higher lesion contour sharpness of esophageal carcinoma than conventional endoscopy,NBI-based lesion grading has a significant value in the prognosis of esophageal carcinoma,and NBI combined with BME and CT can effectively evaluate the short-term effect of radiotherapy on the malignancy.