临床分期对食管癌根治手术患者生存状况的预测效果  

Effect of clinical staging on predicting survival of esophageal cancer patients with radical surgery

作　　者：林富强[1] 谢德耀[1] 程德志[1] 刘瑜[1] 林超西[1] 

机构地区：[1]温州医科大学附属第一医院胸外科,浙江温州325000

出　　处：《中国现代医学杂志》2015年第10期74-78,共5页China Journal of Modern Medicine

摘　　要：目的 探讨临床分期对食管癌根治手术患者生存状况的预测效果。方法 收集2004年6月-2009年6月在该院行食管癌根治手术的278例患者的术前CT、食管镜、超声内镜（EUS）、食管造影及术后病理分期等资料,分别按2002和2009年国际抗癌联盟（UICC）病理分期及影像学临床分期分析食管癌患者术后5年生存率,探讨影像学术前分期对非手术食管癌预后的评估价值。结果 术后对患者随访时间为6-70个月,中位随访时间为52个月,共有262例患者获得完整的随访,随访率为94.24%。262例患者5年生存率为32.06%（84/262）,临床T分期、临床N分期、2002和2009年UICC各分期间5年生存率均有统计学意义（P〈0.05）,但2009年UICC各分期两两比较差异无统计学意义（P〉0.05）,而临床T分期、2002年UICC中各分期两两比较差异有统计学意义（P〈0.05）。CT对食管癌淋巴结转移阴性预测值为92.86%（182/196）,对上纵膈、下中下纵膈及腹腔的阳性预测值分别为54.54%（12/22）、42.86%（6/14）、33.33%（5/15）。结论 2002年UICC较2009年UICC临床分期更可靠有效,且易于掌握。CT检查尽管不能准确、有效提供淋巴转移个数,但对淋巴结定性具有较高的预测价值。术前应用EUS＋CT对食管癌进行临床分期可有效预测患者预后。[ Objective] To investigate the prediction effect of clinical staging on living conditions of patients with esophageal cancer surgery. [Methods ] The data of preoperative CT, esophagoscopy, endoscopic ultrasound （EUS）, esophageal radiography and postoperative pathological staging were collected front 278 cases underwent esophageal cancer radical surgery from June 2004 to June 2009. The 5-year survival rate of esophageal cancer patients was analyzed with 2002 and 2009 UICC （International Union Against Cancer） staging system respectively. The appraised value of preoperative imaging staging in non-surgical esophageal cancer prognosis was anlayzed. [ Results ] All patients were followed up for 6 to 70 months. The median follow-up time was 52 months. There were 262 patients were completely followed up. The follow-up rate of patients was 94.24%. The 5-year survival rate of 262 patients was 32.06% （84/262）. The 5-year survival rate of clinical T stage, clinical N stage, 2002, 2009 UICC staging were statistically significant （P 〈 0.05）, 5-year survival rate of 2009 UICC staging for each pairwise comparison was not significantly different （P 〉 0.05）, and each pairwise comparisons of clinical T stage, 2002 UICC staging were significantly different （P 〈 0.05）. Negative predictive value of CT for detecting lymph node metastasis was 92.86%（182/196）, and the upper mediastinal, lower middle and lower mediastinal and abdominal positive predictive value were 54.54% （12/ 22）, 42.86% （6/14）, 33.33% （5/15）. [Conclusions] 2002 UICC clinical staging is more reliable and effective, and easy to grasp. Although CT examination can not accurately and efficiently provide the number of lymph node metastasis, but has a high predictive value for qualitative diagnosis. Preoperative application of EUS＋CT clinical staging of esophageal cancer can effectively predict the prognosis of patients.

关 键 词：临床分期 食管癌 生存状况 预测价值 

分 类 号：R735.1[医药卫生—肿瘤]