食管癌AJCC/UICC第6、7版TNM分期分段方法在放疗患者中的比较  

Comparison of 6^(th) and 7^(th) Editions of AJCC/UICC TNM Staging for Esophageal Cancer Patients Received Radiotherapy

作　　者：周志国[1] 甄婵军[1] 梁军利[1] 张萍[1] 刘欣[1] 白文文[1] 乔学英[1] 宋玉芝[1] 高献书[2] 

机构地区：[1]河北医科大学第四医院放疗五病区,石家庄050011 [2]北京大学第一医院放射治疗科,北京100034

出　　处：《肿瘤防治研究》2015年第8期772-776,共5页Cancer Research on Prevention and Treatment

摘　　要：目的探讨食管癌AJCC/UICC第6、第7版分期中分段方式在放射治疗患者中应用的合理性及对预后的影响。方法对符合入组条件的265例食管癌放射治疗患者进行回顾分析,依照AJCC/UICC2009年第7版食管癌TNM分期标准及第6版食管癌TNM分期标准中的分段方法,进行分段比较分析,并进行单因素、多因素生存分析。结果按照AJCC/UICC第7版食管癌TNM分期中的分段标准,食管原发灶位于颈段46例、胸上段76例、胸中段83例、胸下段60例。按照第6版食管癌TNM分期中分段标准,食管原发灶位于颈段16例、胸上段83例、胸中段132例、胸下段34例。根据两种分段结果是否一致分为两组:一致组(169例)及差异组(96例),一致组中颈段及胸上、中、下段食管癌患者1、2、3年生存率分别为70.6%、64.7%、6 4.7%;8 4.3%、5 7.8%、5 3.6%;5 3.4%、3 2.7%、2 1.0%及7 1.4%、40.2%、40.2%(P=0.001)。差异组中,各段生存率未见差异。Cox回归模型多因素生存分析,结果显示第6版分期的分段方式及放疗剂量对预后的影响有统计学意义。结论两种分期方法对颈段、胸中段、胸下段食管癌的判定差异较大,第6版分期标准中的分段方法可以较好预测放疗患者的生存,颈段、胸上段食管癌患者放疗后生存优于胸中、下段食管癌患者。Objective To evaluate the reasonability of the 6th and 7th editions of American Joint Committee on Cancer/Union for International Cancer Control(AJCC/UICC) tumor node metastasis(TNM) staging for esophageal carcinoma in radiotherapy and their effect on prognosis. Methods We retrospectively analyzed 265 esophageal carcinoma patients received radiotherapy. In accordance with different definition about location segment in the 6th and 7th edition of AJCC/UICC TNM staging for esophageal carcinoma, we analyzed and evaluated the prognosis by univariate and multivariate survival analysis. Results According to the 7thedition of AJCC/UICC TNM staging for esophageal carcinoma, the number of esophagus primary lesions in cervical, upper, middle and inferior thoracic portion were 46, 76, 83 and 60, respectively, according to the 6thedition, the number were 16, 83, 132 and 34, respectively. All patients were divided into two groups according to the two methods, the consistent group(169 cases) and the difference group(96 cases). In consistent group, the 1-, 2-, 3-year survival rates of patients with esophageal carcinoma in cervical, upper, middle and inferior thoracic portion were 70.6%, 64.7%, 64.7%;84.3%, 57.8%, 53.6%;53.4%, 32.7%, 21.0% and 71.4%, 40.2%, 40.2%, respectively(P=0.001). The difference wasn't significant statistically in the difference group. Multivariate analysis showed that age, the 6th edition of TNM staging and radiation dose were independent factors for the survival. Conclusion The difference of two staging methods on the esophageal carcinoma in cervical, middle and inferior thoracic portion is obvious. The 6th edition of AJCC/UICC TNM staging could better predict the survival. The survival of patients with esophageal carcinoma in cervical and upper thoracic portion after radiotherapy is superior to those in the middle and inferior thoracic portion.

关 键 词：食管癌 放射治疗 第6版AJCC/UICC TNM分期 第7版AJCC/UICC TNM分期 预后 

分 类 号：R735.1[医药卫生—肿瘤]