食管癌临床分期对三维适形放射治疗预后的影响

目的 分析食管癌三维适形放射治疗的预后影响因素,评价食管癌临床分期对判断预后的价值。方法回顾性分析资料完整的81例接受三维适形放疗的食管癌患者,对可能影响预后的因素进行多因素分析,并比较肿瘤局部T分期、N分期和临床分期与预后的关系。结果全组患者1、2、3、4年总生存率分别为67.9%、45.7%、40.5%和30.9%,1、2、3、4年局部控制率分别为83.0%、76.1%、73.9%和69.8%。放疗前X射线病变长度、病变局部T分期、临床分期、食管GTVD₉₅为影响患者总生存率的独立预后因素。T₁+T₂期与T₃、T₄期比较,临床Ⅰ+Ⅱ与临床Ⅲ、Ⅳ期比较,总生存率、局部控制率、无远处转移生存率及无瘤进展生存率的差异均有统计学意义。N₀期与N₁、N₂期比较,除局部控制率外,总生存率、无远处转移生存率及无瘤进展生存率差异均有统计学意义。临床Ⅲ期与Ⅳ期之间除局部控制率差异无统计学意义外(χ²=2.03,P=0.155),总生存率、无远处转移生存率及无瘤进展生存率比较差异均有统计学意义(χ²值分别为5.38、4.26、3.96,P值分别为0.020、0.039、0.045 )。结论食管癌临床分期的四分类法是非手术治疗食管癌比较理想的分期方法,能较好地预示放射治疗的预后。

Prognostic effect of clinical staging for esophageal carcinoma patients with three-dimensional conformal radiotherapy

Objective To study the prognostic factors in esophageal cancer patients after three-dimensional conformal radiotherapy(3DCRT)using Cox proportional hazard model and to evaluate the validity of the clinical staging.Methods Eight-one esophageal carcinoma patients treated by 3DCRT were analyzed retrospectively,and several factors including the local T staging of tumor.N staging and the clinical staging were analyzed using Cox proportional hazard model.The correlation of the local T staging of tumor and the clinical staging with prognosis was studied.Results The 1-,2-,3-and 4-year overall survival rate was 67.9%,45.7%,40.5%and 30.9%,respectively.The 1-,2-,3-,4-year local control rate was 83.0%,76.1%,73.9%and 69.8%,respectively.Multivariate analysis showed that the size of tumor,the local T staging of tumor,the clinical stage and esophageal GTVD95 were independent prognostic factors.There were significant differences between the local T staging of tumor and the clinical staging in terms of overall survival,local-regional control,distant metastasis-free survival and disease-free survival(all P<0.05).There were significant differences between stage Ⅲ and stage Ⅳ in terms of overall survival.distant metastasis-free survival and disease-free survival(P=0.020,0.039,0.045),except for the local-regional control(P=0.155).The stage N0 had the same results with stage N1,and N2.Conclusions The four-stage system is optimal for non-operative esophageal cancer in clinical staging and it can be used to predict prognosis.