基于IMRT同步化疗疗效的食管鳞癌非手术分期临床分析

目的 对IMRT同期化疗食管癌病例采用不同分期标准进行验证比较,探讨更准确、更适用的非手术治疗临床分期标准。方法 选取2008—2014年间就诊于本院242例IMRT化疗食管鳞癌患者的临床资料,用2009年中国分期、第6版分期和建议分期进行预后判断比较。Kaplan-Meier法计算生存率并Logrank检验,Cox模型预后分析。结果 3年样本数168例。全组患者3年生存率为47.4%,食管肿瘤体积和淋巴结转移最大径是影响预后的因素(P=0.000、0.000)。中国分期和第6版分期T₃、T₄期生存曲线有交叉(P=0.696、0.594),中国分期的N₁、N₂期生存曲线有交叉(P=0.068);建议分期采用食管肿瘤体积的T分期、淋巴结转移最大径的N分期以及结合的临床分期,各期的生存曲线分离度较好(P=0.000、0.000、0.000)。结论 采用食管肿瘤体积的T分期和淋巴结转移最大径的N分期结合进行IMRT化疗食管鳞癌的非手术临床分期能较好预测患者预后,简便易行。

Clinical study of non-operative staging of esophageal squamous cell carcinoma underwent intensity-modulated radiotherapy combined with chemotherapy

Objective To compare different non-operative clinical staging criteria regarding their accuracy and feasibility in evaluation of patients with esophageal squamous cell carcinoma (ESCC) receiving concurrent intensity-modulated radiotherapy (IMRT) and chemotherapy.Methods A study was performed on clinical data from 242 ESCC patients who received concurrent IMRT and chemotherapy in our hospital from 2008 to 2014.Prognostic prediction was compared between the Chinese 2009 staging system,the 6th edition staging system,and a suggested staging system.The survival rates were calculated by the KaplanMeier method and analyzed by the log-rank test.A prognostic analysis was made by the Cox model.Results The 3-year sample size and overall survival rate were 168 and 47.4％,respectively.Esophageal tumor volume and the maximum diameter of metastatic lymph nodes were prognostic factors (P=0.000,0.000).An intersection of T3 and T4 survival curves was found in the Chinese staging system and the 6th version staging system (P=0.696,0.594),while an intersection of N1 and N2 survival curves was found in the Chinese staging system (P=0.068).The T staging based on esophageal tumor volume,N staging based on the maximum diameter of metastatic lymph nodes,and their combination could achieve a good separation of survival curves of different stages (P=0.000,0.000,0.000).Conclusions The T staging based on esophageal tumor volume combined with the N staging based on the maximum diameter of metastatic lymph nodes is an convenient non-operative clinical staging approach for prognostic prediction of ESCC patients receiving concurrent IMRT and chemotherapy.