食管癌患者肿瘤体积对 T分期及预后的影响分析

目的：探讨食管癌患者大体肿瘤体积（ gross tumor volume，GTV）对T分期及预后的影响。方法收集198例行根治性切除治疗的食管癌患者的临床资料，观察不同GTV分级的病理T分期分布情况、5年生存情况以及局部区域复发率和远处转移率。结果 GTV 分级与T 分期总符合率为72．16％，一致性分析显示两者存在一致性（ Kappa ＝0．402，P＜0．01）。随着GTV分级升高T分期逐渐增加，且相邻T分期GTV分布有重叠现象；随着GTV分级升高食管癌患者整体生存率呈逐渐下降趋势，差异具有统计学意义（χ2＝21．900，P＝0．000）。 GTVⅠ级组和Ⅱ级组1、3、5年生存率及平均生存时间均显著高于GTVⅢ级组，差异具有统计学意义（P＜0．05）。随着GTV分级升高食管癌患者整体局部区域复发率先下降后升高，差异具有统计学意义（χ2＝7．58，P＝0．023）；随着GTV分级升高食管癌患者整体远处转移率呈现逐渐升高趋势，但差异无统计学意义（χ2＝0．579，P＝0．797）。结论随着食管癌患者GTV增大T分期逐渐增加，5年生存率逐渐下降，局部复发率和远处转移率逐渐增加。

Effect of Tumor Volume and Pathological T Staging on Prognosis of Esophageal Carcinoma

Objective To explore the effect of gross tumor volume( GTV) and pathological T staging on prognosis of e-sophageal carcinoma.Methods 198 cases of patients with esophageal cancer were treated by radical resection.The pathological T staging,5-year survival,recurrence rate,and distant metastasis rate in different GTV classification were observed.Results The total consistent rate of GTV classification and pathological T staging was 72.16%,there with consistency between them( Kappa=0.402,P<0.01);The T staging gradually increased with GTV classification,adjacent T staging GTV distribution had overlap phenomenon;The overall survival rate was reduced with the increase of GTV classification(χ2 =21.900,P=0.000);The 1-,3-, 5-year survival rates of GTVⅠandⅡand mean survival time were higher than GTVⅢ( P<0.05);The recurrence rate of over-all local area reduced and then increased as GTV staging increased(χ2 =7.58,P=0.023);There was no significant difference in the distant metastasis rate(χ2 =0.579,P=0.797);The distant metastasis rate of GTV Ⅱ was lower than that of GTV Ⅲ( P<0.05).Conclusion The pathological T staging increases as GTV increases in patients with esophageal cancer,the 5-year surviv-al rate reduces,local recurrence and distant metastasis rates increase.