1162例食管癌病理标本亚临床病灶范围的研究  

Signiflcance of microscopic extention from 1162 esophageal carcinoma specimens

作　　者：王军[1] 祝淑钗[1] 韩春[1] 张辛[1] 肖爱勤[1] 麻国新[1] 

机构地区：[1]河北医科大学第四医院放疗科,石家庄050011

出　　处：《中华放射肿瘤学杂志》2007年第1期6-9,共4页Chinese Journal of Radiation Oncology

摘　　要：目的研究食管癌病理组织学标本纵轴方向亚临床病灶侵犯范围，为食管癌放疗CTV范围的确定提供参考。方法分析1162例颈、胸段食管癌手术标本的癌上、癌下切除长度与残端阳性的关系。52例食管癌手术标本制成病理大切片，测量标本固定后食管癌及其癌上、下正常组织收缩比例，回推食管癌CTV范围在人体内的实际情况。结果标本固定后，癌上切除范围≤0．5cm组上残端阳性率高于癌上切除范围＞0．5cm组（16．4％：4．1％，P=0．000）；癌下切除范围≤1．5cm组下残端阳性率高于癌下切除范围＞1．5cm组（8．1％：0．4％，P=0．000）；癌上、癌下切除正常组织范围＞1．5cm时上残端阳性率高于下残端阳性率（3．5％：0．4％，P=0．000）。52例食管癌标本制成病理大切片后癌上组织收缩为术中长度的30％±14％，癌下组织收缩为术中长度的44％±19％。结论考虑到标本固定后正常食管的收缩率，食管癌放疗时CTV在GTV范围纵向上外扩2．0cm，纵向下外扩3．5cm可能是较为合适的范围。食管癌上行型侵犯概率高于下行型侵犯。Objective To examine the subclinical microscopic tumor extention along the long axis in 1162 specimens of esophageal carcinoma so as to help define the clinical target volume（CTV） according to the degree of microscopic extention（ME） for radiotherapy for esophageal carcinoma. Methods 1162 resected esophageal carcinoma specimens originally located in the neck and thorax were studied with special reference to the correlation between upper and lower resection length from the tumor and positive microscopic margin. Another 52 resected esophageal carcinoma specimens were made into pathological giant sections： the actual resection length of upper and para-esophageal normal tissues was compared with that of the lower normal tissues from the tumor, there by, the ratio of shrinkage was obtained and compared. Results After fixation, microscopic positive margin ratio of the upper resection border in length ≤0.5 cm group was higher than that in length 〉 0.5 cm group（16.4% vs 4. 1% , P =0.000）. Microscopic positive margin ratio of the lower resection border in length ≤1.5 cm group was higher than that in length 〉 1.5 cm group（8.1% vs 0.4% , P = 0.000）. This showed that the positive margin ratio of the upper border was higher than that of the lower border in resection length 〉 1.5 cm group（3.5% vs 0.4%, P =0.000）. The actual length of upper and lower normal esophageal tissue after having been made into pathological giant sections in 52 patients, was 30% ± 14% and 44% ± 19% of that measured in the operation. Conclusions Considering the shrinkage of the normal esophagus during fixation, a CTV margin of 2.0 cm along the upper long axis and 3.5 cm along the lower long axis should be chosen for radiotherapy for esophageal carcinoma, according to the ratio of shrinkage. Ascending invasion proportion is higher than the descending invasion in that tumor.

关 键 词：食管肿瘤 临床靶体积 放射疗法 

分 类 号：R686[医药卫生—骨科学]