非手术治疗食管癌临床分期的验证

[目的]对中国《非手术治疗食管癌临床分期标准(草案)》进行验证,为该草案进一步修订提供依据。[方法]收集2005~2006年行根治性三维适形放射治疗的食管癌患者236例,颈段25例,胸上段76例,胸中段118例,胸下段17例。放疗中位剂量64Gy(50~74Gy),其中有76例(32.2%)接受了以铂类为主的同期化疗。根据分期草案的标准进行T、N及临床分期,比较不同分期与总生存率的关系。[结果]73例生存患者的中位随访时间为50(10~72)个月,5年总生存率为26.2%。236例患者中,T1、T2、T3和T4的5年生存率分别为100%、35.2%、24.3%、19.8%(P=0.006),生存曲线均无交叉。N0、N1和N2的5年生存率分别为50.7%、16.5%、23.7%(P=0.087),其中N2组与N1组生存曲线存在交叉。Ⅰ、Ⅱ和Ⅲ期5年生存率分别为50.7%、0和23.7%(P=0.033),Ⅱ、Ⅲ期生存曲线有交叉。有30例胸段食管癌存在胸廓入口以上食管旁小淋巴结转移(5mm<最长径<10mm),如将这部分患者N分期定义为N1,则N0、N1和N2的5年总生存率分别为34.3%、26.6%和19.4%(P=0.029),各期生存曲线均能很好分开;由此定义的临床分期Ⅰ、Ⅱ和Ⅲ期5年生存率分别为50.7%、31.2%和20.7%(P=0.009),各期生存曲线均能很好分开。[结论]非手术治疗食管癌临床分期草案T分期可以较好地反映预后,N分期标准存在不足。建议将有胸段食管癌胸廓入口以上单纯食管旁小淋巴结转移(最长径<10mm)者定义为N1。

Verification of Non-surgical Clinical Staging for Esophageal Carcinoma

[Purpose] To verify the Chinese version of protocol of staging system for esophageal carcinoma who received nonsurgical treatment and to provide evidence for its further revision.[Methods] From 2005 to 2006,236 cases with esophageal carcinoma receive three dimensional radiation therapy were enrolled.The numbers of patients with primary tumor location in the neck,upper,middle and lower thorax were 25,76,118 and 17 respectively.The median radiation dose was 64Gy(50~74Gy).Seventy six cases(32.2%) received cisplatin-based concurrent chemotherapy.All patients were staged according to the Chinese version of protocol of staging system for esophageal carcinoma who received nonsurgical treatment.The correlation between stage and survival rate was evaluated.[Results] Seventy three cases survived with a median follow-up of 50 months(10~72months),the 5-year overall survival rate was 26.2%.The 5-year overall survival rate in patients at T1,T2,T3 and T4 was 100%,35.2%,24.3% and 19.8% respectively(P=0.006).The separation of survival cures showed reasonable results.The 5-year overall survival rate in patients at N0,N1 and N2 were 50.7%,16.5% and 23.7% respectively(P=0.087),The survival curves of N1 and N2 were crossed.The 5-year overall survival rate in patients at stage Ⅰ,Ⅱ and Ⅲ were 50.7%,0 and 23.7% respectively(P=0.033),the survival curves for stageⅡ and Ⅲ were crossed as well.Thirty thoracic cases were found with merely paraesesophageal metastatic lymph nodes(5mm