病理特征在食管鳞癌放疗临床靶体积外放边界确定中的价值

目的 研究食管鳞癌镜下浸润转移特点及临床病理特征对其影响,为食管鳞癌临床靶体积(CTV)边界确定提供参考依据.方法 根据每个标本的收缩比计算食管组织体内每厘米长度对应的固定后长度并取材,观察64例标本肿瘤外纵向每厘米范围浸润转移情况.结果 浸润转移阳性率随着距肿瘤边缘距离增加而降低,近端和远端3 cm组出现浸润转移概率分别为4.8%和6.9%,4 cm组分别为3.6%和3.6%.肿瘤长度>5 cm、分化程度低、有淋巴结转移、T3期病例浸润转移发生率高(79.3%:45.7%、77.4%:45.5%、76.0%:51.2%、70.5%:40.0%,χ2=7.52、6.86、3.91、5.36,P=0.006、0.009、0.042、0.021).分化程度、肿瘤长度是影响食管鳞癌浸润转移的主要因素(χ2=0.19、4.82,P=0.020、0.017).结论 食管鳞癌精确放疗若要包括95%的浸润转移病灶CTV应在大体肿瘤体积(GTV)基础上纵向上放3 cm、下放4 cm,若要包括90%的浸润转移病灶则需在GTV基础上上、下均外放3 cm.同时要综合考虑病理特征对靶区范围的影响.

Abstract：

Objective To study the characteristics of microscopic spread of esophageal squamous-cell carcinoma (ESCC) and the influence of clinicopathological features on it to help define the clinical target volume (CTV) margin in radiotherapy.Methods Sixty-four surgical specimens of ESCC were observed for longitudinal microscopic spread per centimeter both proximally and distally from the tumor.The shrinkage ratio of each specimen was calculated and used for tissue incision.Results The further the distance beyond the tumor, the lower the incidence there was of microscopic spread.Positive rates of microscopic spread in group 3 cm of proximal and distal were 4.8% and 6.9%, respectively, and in group 4 cm were both 3.6%.Tumors longer than 5 cm in length,with poorer differentiation, lymph nodes metastasis and more aggressive phase had higher positive rates (79.3% vs 45.7%,77.4% vs 45.5%,76.0% vs 51.2%,70.5% vs 40.0%,χ2=7.52,6.86,3.91,5.36;P=0.006,0.009,0.042,0.021).Differentiation and tumor length were main factors contributing to microscopic spread (χ2=0.19,4.82;P=0.020,0.017).Conclusions To cover 95% of the microscopic spread,a margin of 3.0 cm proximal and 4.0 cm distal beyond gross tumor volume is needed and as to 90%, a margin of 3.0 cm both proximal and distal is needed.Moreover, the influence of pathological features should be taken into account.

Value of pathological features in defining the longitudinal margin of the clinical target volume in radiotherapy of esophageal squamous-cell carcinoma

Objective To study the characteristics of microscopic spread of esophageal squamous-cell carcinoma (ESCC) and the influence of clinicopathological features on it to help define the clinical target volume (CTV) margin in radiotherapy.Methods Sixty-four surgical specimens of ESCC were observed for longitudinal microscopic spread per centimeter both proximally and distally from the tumor.The shrinkage ratio of each specimen was calculated and used for tissue incision.Results The further the distance beyond the tumor, the lower the incidence there was of microscopic spread.Positive rates of microscopic spread in group 3 cm of proximal and distal were 4.8% and 6.9%, respectively, and in group 4 cm were both 3.6%.Tumors longer than 5 cm in length,with poorer differentiation, lymph nodes metastasis and more aggressive phase had higher positive rates (79.3% vs 45.7%,77.4% vs 45.5%,76.0% vs 51.2%,70.5% vs 40.0%,χ2=7.52,6.86,3.91,5.36;P=0.006,0.009,0.042,0.021).Differentiation and tumor length were main factors contributing to microscopic spread (χ2=0.19,4.82;P=0.020,0.017).Conclusions To cover 95% of the microscopic spread,a margin of 3.0 cm proximal and 4.0 cm distal beyond gross tumor volume is needed and as to 90%, a margin of 3.0 cm both proximal and distal is needed.Moreover, the influence of pathological features should be taken into account.