探讨非手术食管癌临床分期有效性与预测预后价值  

Efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer

作　　者：刘晓[1] 王贵齐[2] 贺舜[2] 秦秀敏[2] 王铸[3] 屈东[3] 邵华飞[3] 程贵余[4] 刘向阳[4] 周宗玫[1] 肖泽芬[1] 贺捷[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院放疗科,100021 [2]北京协和医学院中国医学科学院肿瘤医院腔镜科,100021 [3]北京协和医学院中国医学科学院肿瘤医院影像科,100021 [4]北京协和医学院中国医学科学院肿瘤医院胸外科,100021

出　　处：《中华放射肿瘤学杂志》2014年第1期17-22,共6页Chinese Journal of Radiation Oncology

基　　金：首都特色临床应用研究（Z121107001012004）;首都医学发展基金（2007-2022）

摘　　要：目的探讨非手术食管癌临床分期的有效性及预测预后的临床价值。方法分析2003-2010年期间在本院行食管癌根治术，术前有EUS、食管镜、CT、食道造影等详细检查，术后有详细病理分期的358例患者资料。分析术前影像学分期与术后病理分期的预测值，分别按2002、2009年UICC病理分期及临床分期，分析患者无瘤生存及总生存。结果全组中位随访时间47个月，随访率为97．2％。有EUS＋CT检查并能进行有效分期的305例（85．2％）。在305例中临床T分期对病理T分期的预测值为0-88．6％，其中T，期最高（88．6％）、T。期最低；临床N分期（N0、N1期）的预测值为62．5％-100％。虽然2002、2009年的分期间总生存率及无瘤生存率差异均有统计学意义（P=0．000、0．000），但2002年的分期内总生存除Ⅳ期只有2例与各期别相似外差异均有统计学意义，2009年的分期内总生存各期别差异无统计学意义。按2002年UICCTNM分期标准对305例进行EUS＋CT临床分期的总生存及无瘤生存均有差异统计学意义（P=0．000、0．000）。结论影像学检查不能有效、准确提供淋巴结转移个数，但对淋巴结定性的预测值较高。EUS＋CT的临床分期能有效预测非手术食管癌的预后。Objective To investigate the efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer （EC）. Methods A retrospective study was conducted in 358 EC patients who underwent radical surgery in our hospital from April 2003 to October 2010 and who had preoperative work-up including endoscopic esophageal ultrasound （EUS）, esophagoscopy, thoracic CT scans, and contrast esophagography and had detailed information on postoperative pathological stages. The predictive value of preoperative clinical T/N stage based on EUS ＋ CT for postoperative pathological stage was analyzed. The disease- free survival （DFS） and overall survival （OS） were analyzed according to the UICC TNM classification （2002/ 2009） and the clinical stage based on imaging findings. Results The median follow-up was 47 months. A total of 305 （85.2%） of all patients were analyzed by clinical stage based on EUS ＋ CT. Among them, the predictive value of clinical T stage for pathological T stage was 0-88.6% , highest （88.6%） for T1 stage and lowest for T4 stage. The predictive value of clinical N stage （ N0/N1 ） was 62. 5-100%. The significant differences in OS and DFS rates based on both 2002 and 2009 UICC TNM classifications were noted （P = 0. 000 and 0. 000）. There were significant differences in OS between stage groups, except the comparison between two stage Ⅳ patients and other groups, according to 2002 UICC TNM classification. There were usually insignificant differences in OS between stage groups, according to 2009 UICC TNM classification. For the 305 patients staged clinically based on EUS and CT according to 2002 UICC TNM classification, significant differences in OS and DFS rates were noted （ P = 0. 000 and 0. 000）. Conclusions Imaging modalities show good predictive value for N stage （N0/N1）, even though they cannot accurately provide the number of metastatic lymph nodes. The clinical stage based on EUS ＋ CT can effectively predict the prognosis of non-surgical E

关 键 词：食管肿瘤 非手术分期 国际抗癌联盟分期 预后 

分 类 号：R735.1[医药卫生—肿瘤]