基于CT的食管癌非手术N分期研究  

A computed tomography-based study of the non-surgical N staging system for esophageal carcinoma

作　　者：许鸿鹞[1] 李忆璇[1] 吴盛喜[1] 罗何三[1] 黄河澄[1] 林连兴[1] 

机构地区：[1]汕头市中心医院肿瘤放疗科,515031

出　　处：《中华放射肿瘤学杂志》2016年第10期1066-1069,共4页Chinese Journal of Radiation Oncology

摘　　要：目的：更好地完善食管癌非手术N分期。方法回顾分析2009—2013年本院接受放疗的501例初治食管鳞癌患者，分析锁骨上淋巴结、纵隔淋巴结等对OS影响，完善原非手术N分期并对推荐N分期进行评价。 Kaplan-Meier法计算OS率等并Logrank检验和单因素分析，Cox模型多因素分析。结果3、5年样本数分别为404和205例。1、3、5年OS率分别为64.9％、26.5％、18.3％， DMF率分别为86.2％、68.9％、67.3％，LC率分别为72.7％、53.1％、43.6％。单因素分析显示颈段和胸上段食管癌锁骨上淋巴结转移发生率明显高于胸中、下段，分别为25.7％∶14.2％（ P＝0.034），颈段和胸上段食管癌锁骨上淋巴结转移的3年OS率和DMF率明显高于胸中、下段，分别为24.2％∶11.5％（ P＝0.016）和84.8％∶69.2％（ P＝0.007）。多因素分析也显示淋巴结转移个数是影响患者OS、DMF的因素（ P＝0.000、0.007）。结论食管胸上段癌锁骨上淋巴结转移归为N1期是比较合理的；在N分期中加入淋巴结转移个数这个因素后推荐的N分期更加科学客观。Objective To improve the non-surgical N staging system for esophageal carcinoma （ EC） . Methods A retrospective analysis was performed in 501 patients newly diagnosed with esophageal squamous cell carcinoma who received radiotherapy in our hospital from 2009 to 2013. The impacts of the supraclavicular lymph nodes and mediastinal lymph nodes on the overall survival （ OS） rate were analyzed. The original non-surgical N staging system was improved and the proposed N staging system was evaluated. The OS rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The univariate and multivariate analyses were performed using the log-rank test and Cox regression model, respectively. Results The 3-and 5-year sample sizes were 404 and 205, respectively. In all patients, the 1-, 3-, and 5-year OS rates were 64.9%, 26.5%, and 18.3%, respectively;the 1-, 3-, and 5-year distant metastasis-free （ DMF） rates were 86.2%, 68.9%, and 67.3%, respectively;the 1-, 3-, and 5-year local control rates were 72.7%, 53.1%, and 43.6%, respectively. The univariate analysis showed that the incidence, 3-year OS rate, and 3-year DMF rate of supraclavicular lymph node metastases in patients with cervical and upper-thoracic EC were significantly higher than those in patients with middle-thoracic and lower-thoracic EC （ 25.7% vs. 14.2%, P=0.034;24.2% vs. 11.5%, P=0.016;84.8% vs. 69.2%, P=0.007） . The multivariate analysis also showed that the number of metastatic lymph nodes was an independent prognostic factor for the OS and DMF rates in patients （ P= 0.000;P= 0.007 ） . Conclusions It is reasonable to classify upper-thoracic EC with supraclavicular lymph node metastasis into stage N1 diseases. The proposed N staging system with the factor of the number of metastatic lymph nodes is more scientific and objective than the original N staging system.

关 键 词：体层摄影术 X线计算机 食管肿瘤 非手术N分期 

分 类 号：R735.1[医药卫生—肿瘤]