食管癌CT图像GTV与三维放疗预后关系分析  

Analysis of relationship between CT-GTV and prognosis in patients with esophageal cancer after three-dimensional radiotherapy

作　　者：李晓宁[1] 王澜[1] 韩春[1] 孔洁[1] 张靖[1] 田华[1] 高超[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》2014年第1期23-26,共4页Chinese Journal of Radiation Oncology

摘　　要：目的观察食管鳞癌患者CT图像GTV与非手术T分期关系及各级GTV体积的生存率，探讨GTV体积对食管鳞癌三维放疗预后的影响。方法回顾分析2003--2009年间无淋巴结及远处转移的食管鳞癌患者223例，三维放疗处方剂量50～70Gy。依据不同百分位间距将GTV体积按3、4分级法分别划分为3、4个组。Spearman等级相关分析非手术T分期与GTV的关系。Kaplan—Meier法计算生存率并Logrank法检验。结果随访率为98．2％，随访时间满3年者163例。非手术T1＋2、T3、T4期患者GTV体积中位数分别为19．31、33．69、41．25cm3，呈正相关（P=0．000）。GTV3分级3个组的3年生存率分别为59％、43％、24％（P=0．000），4分级4个组的分别为55％、51％、31％、24％（P=0．004）。GTV体积中位数≤35、〉3513113。患者首位死因均为局控失败（57．9％：52．1％），大肿瘤死于未控及出血较多[21．9％：9．4％（P=0．046）及13．8％：3．1％（P=0．029）]，2例治疗相关死亡。结论食管癌放疗患者GTV体积与非手术T分期呈正相关，GTV体积3分级法和4分级法均可用于评价预后，3分级法与预后关系更为紧密。肿瘤体积较大者放疗后未控、出血率高于小肿瘤患者，治疗相关死亡风险高。Objective To observe the relationship between computed tomography-gross tumor volume （GTV） and non-surgical T stage in patients with esophageal squamous cell carcinoma （ESCC） and the survival rates of patients with different GTVs, and to investigate the impact of GTV on the prognosis of ESCC after three-dimensional radiotherapy. Methods A retrospective analysis was performed on 223 ESCC patients without lymph node metastasis and distant metastasis who were hospitalized from July 2003 to January 2009. The prescribed doses of three-dimensional radiotherapy ranged from 50--70 Gy. These patients were divided into 3 or 4 groups according to different percentile intervals of GTVs. The Spearman rank correlation analysis was used for investigating the relationship between non-surgical T stage and GTV. The Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis. Results The follow-up rate was 98.2%. A total of 163 patients were followed up for at least 3 years. The median GTVs of patients with T1＋2 ESCC, T3 ESCC, and T4 ESCC were 19.31 cm3 , 33.69 cm3 , and 41.25 cm3 , respectively, exhibiting a positive correlation between non-surgical T stage and GTV （ P = 0. 000 ）. The 5-year survival rates were 59% , 43% , and 24% （ P = 0. 000 ） in 3 GTV-based groups and were 55% , 51% , 31% , and 24% （P =0. 004） in 4 GTV-based groups. The primary cause of death for the patients with GTVs of ≤35 cm3 and 〉35 cm3 was failure of local control （57.9% vs 52. 1% ） ; 21.9% and 13.8% of the patients with a GTV of 〉 35 cm3 died of uncontrol and excessive bleeding, versus 9.4% and 3.1% of the patients with a GTV of≤35 cm3 （P =0. 046;P =0. 029） ;2 of the patients with a GTV of 〉 35 cm3 died of grade 5 radiation pneumonitis. Conclusions GTV is positively correlated with non- surgical T stage in esophageal cancer patients who receive radiotherapy. The 3-level and 4-level grading of GTV can be used for prognostic evaluation, and the 3-level

关 键 词：食管肿瘤 三维放射疗法 大体肿瘤体积 预后 

分 类 号：R735.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]