食管癌非手术治疗临床分期新标准的对比研究

目的 比较不同食管癌临床分期对同一组病例的预测价值,并完善T分期标准,为更准确进行临床分期提供参考。方法 回顾分析我院701例根治性放疗食管癌患者,分别按AJCC标准、2004年标准、2009年草案标准并结合GTV-T体积标准进行预后判断。结果 按3种标准进行T分类后,发现AJCC分期偏早,T₁期达23.1%,且T₃与T₄期的生存曲线接近。2004年标准下各期生存曲线分离度均较好,但T₁和T₄期者偏少,分布不均。2009年草案标准中T₃和T₄期生存曲线交叉且T₄期较多达43.2%。根据GTV大小及病变对周围组织器官侵及程度行新T分期,各期生存曲线未见交叉,所占比例较均衡。N分期仍采用N₀、N₁、N₂期分类法,将N分期与新T分期结合进行TNM分期,所得各期生存曲线分离度均很好(P=0.000)。结论 将食管癌局部肿瘤体积大小结合外侵程度确定的T分期与区域内外淋巴结转移确定的N分期联合,能比较准确地预测非手术治疗患者的生存预后。

A comparative study of new clinical staging systems for esophageal carcinoma treated with non-surgical therapy

Objective To evaluate the predictive values of different systems for clinical staging of esophageal carcinoma in one group of patients and improve the criteria for T staging,and to provide a basis for accurate clinical staging. Methods A retrospective study was performed in 701 patients with esophageal carcinoma who received radical radiotherapy in our hospital. The prognosis was performed according to American Joint Committee on Cancer ( AJCC) tumor-node-metastasis staging system,Chinese 2004 staging system,the draft of Chinese 2009 staging system,and gross tumor volume of the primary tumor (GTV-T). Results In terms of T stage,patients evaluated according to the AJCC staging system were in relatively early stages;23. 1% of them were in stage T1,and the survival curves of T3 and T4 patients were close to each other;the survival curves plotted according to the Chinese 2004 staging system were well separated, but relatively few patients were in stages T1 and T4 , yielding an uneven distribution;according to the draft of Chinese 2009 staging system, the survival curve of T3 patients intersected that of T4 patients, and up to 43. 2% of patients were in stage T4.The new T staging was performed based on GTV and the extent of tumor invasion into the adjacent tissue and organ, and the results showed that there was no intersection between survival curves and a relatively balanced T stage distribution. In terms of N staging,patients were divided into stages N0 ,N1 ,and N2 . The TNM staging was performed by a combination of N staging and new T staging, resulting in significant separation between survival curves ( P=0. 000) . Conclusions The combination of T staging,which is based on GTV and the extent of tumor invasion,and N staging,which is based on metastasis of lymph nodes, can accurately predict the survival of non-surgically treated patients with esophageal carcinoma.