Correlation between GTV-T Volume, Clinical Stage and Prognosis of Esophageal Carcinoma Patients Treated with Three-dimensional Conformal Radiotherapy
-
摘要: 目的 探讨应用肿瘤体积大小评价食管癌临床分期标准的准确性、符合程度及其与预后的关系。方法 分析接受根治性三维适形放疗(three-dimensional conformal radiotherapy, 3DCRT)的375例食管癌患者临床资料,选择合适的GTV-T体积分级标准,结合区域淋巴结转移情况进行临床分期,并结合患者预后进行分析。结果 与病理T分期对应,将GTV-T体积按≤30 cm3、30~≤60 cm3、60~90cm3、>90 cm3分为T1、T2、T3、T4四级,5年生存率之间比较,T3与T4级之间差异无统计学意义(P=0.556),而按T1、T2、T3+4三分级,各T分级之间的生存差异有统计学意义(P<0.001)。无区域淋巴结转移N0者较有区域或非区域淋巴结转移N1~2者预后好(P=0.000)。对应GTV-T体积T1、T2、T3+4三分级,将食管癌临床分期对应分为Ⅰ、Ⅱ、Ⅲ期,将出现N2期或远处转移的患者,全部归入Ⅳ期,各期生存差异具有统计学意义(P<0.001)。结论 GTV-T按T1、T2、T3+4三分级法能较好地反映预后生存;对应GTV-T三分级的临床四分期法,亦能较好的反应预后。Abstract: Objective To evaluate the accuracy and coincidence degree of clinical stage of esophageal carcinoma and to assess the prognosis by applying the size of tumor volume. Methods We retrospectively analyzed the clinical data of 375 patients with esophageal carcinoma treated by radical three-dimensional conformal radiotherapy(3DCRT). GTV-T stage was carried out to these patients as classification standard of clinical T stage of esophageal carcinoma. We proposed the clinical stage of these patients combining with lymph node metastasis, furthermore, we evaluated the accuracy of the classification standard referring to the prognosis of these patients. Results Corresponding to pathological stage T, GTV-T volume were classified into 4 levels, T1, T2, T3 and T4, according to ≤30 cm3, 30-≤60 cm3, 60-90 cm3 and>90 cm3. According to survival curves of patients, there was no significant difference between stage T3 and T4(P=0.556), while GTV-T volume were classified into 3 levels according to T1, T2 and T3+4, there was significant difference among each group(P<0.001). Stage N0 esophageal carcinoma patients without regional lymph nodes had a better prognosis than stage N1-2 ones with or without regional lymph nodes(P=0.000). Clinical stage of esophageal carcinoma was divided into stageⅠ, ⅡandⅢ according to stage T1, T2 and T3+4 of GTV-T volume. The patients with stage N2 or distant metastasis were classified as stage Ⅳ. There was significant difference among each stage(P<0.001). Conclusion GTV-T volume is a good prognosis factor according to three-classification by stage T1, T2 and T3+4. In responding to GTV-T three-classification, clinical fourclassification could also reflect prognosis well.
-
Key words:
- GTV-T volume /
- Clinical stage /
- Esophageal carcinoma /
- Prognosis
-
-
[1] Zhu SC, Li R, Li J, et al. Preliminary study of clinical staging of moderately advanced and advanced thoracic esophageal carcinoma treated by non-surgical methods[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2004, 13(3):189-92. [祝淑钗, 李任, 李娟, 等. 非手术治疗胸段食管癌临床分期与预后关系的初步 探讨[J] 中华放射肿瘤学杂志, 2004, 13(3): 189-92.] [2] Huang WP, Xu JS, Chen JR, et al. CT features of lymph node metastases of thoracic esophageal carcinoma[J]. Zhongguo Lin Chuang Yi Xue Ying Xiang Za Zhi, 2009, 20(4): 236-9. [黄伟鹏, 许建生, 陈洁容, 等. 胸段食管癌淋巴结转移分布特征的螺旋 CT表现[J]. 中国临床医学影像杂志, 2009, 20(4): 236-9.] [3] Wang XF, Zheng XZ, Jin HX. Imaging diagnosis methods and progress for lymph node metastasis in esophageal carcinoma[J]. Zhong Liu Yan Jiu Yu Lin Chuang, 2009, 21(5): 356-8. [王秀芳, 郑玄中, 靳宏星. 食管癌淋巴结转移影像诊断方法及进展[J]. 肿 瘤研究与临床, 2009, 21(5): 356-8.] [4] Li CY, Liu M, Zhang JJ, et al. Assessment of diagnostic criterion for mediastinal lymph node metastasis of esophageal carcinoma[J]. Zhongguo Yi Xue Ying Xiang Ji Shu, 2002, 18(11): 1125-7. [李彩 英, 刘明, 彰俊杰, 等. 胸段食管癌纵隔淋巴结转移诊断标准的 探讨[J] 中国医学影像技术, 2002, 18(11): 1125-7.] [5] The chinese expert group of non-operation treatment of clinical staging of esophageal cancer. Clinical non-operation therapy of esophageal cancer staging standerd(Draft)[C]. The Fifth National Symposium on esophageal cancer radiotherapy. Shijiazhuang, 20 09. [中国非手术治疗食管癌临床分期专家小组. 非手术治疗 食管癌的临床分期标准(草案)[C]. 第五届全国食管癌放射 治疗研讨会. 石家庄, 2009.] [6] Xu Q, Zhu SC, Liu ZK, et al. Exploration of the classification of gross tumor volume and pathological staging of esophageal carcinoma[J]. Zhonghua Zhong Liu Za Zhi, 2010, 32(6): 432-5. [许茜, 祝淑钗, 刘志坤, 等. 食管癌大体肿瘤靶区的体积分级与 病理T分期的关系[J]. 中华肿瘤杂志, 2010, 32(6): 432-5.] [7] Stein HJ, Feith M, Bruecher BL, et al. Early esophageal cancer pattern of lymphatic spread and prognostic factors for longterm survival after surgical resection[J]. Ann Surg, 2005, 242(4): 56 6-73. [8] Wang YX, Zhu SC, Su JW, et al. Analysis of three-dimensional conformal radiotherapy(3D-CRT) for esophageal carcinoma with or without nodal metastasis[J]. Zhongguo Zhong Liu Lin Chuang, 20 11, 38(1): 36-41. [王玉祥, 祝淑钗, 苏景伟, 等. 淋巴结转移 对食管癌三维适形放疗疗效的影响[J]. 中国肿瘤临床, 2011, 38 (1): 36-41.] [9] Jiang J, Wang QF, Xiao ZF, et al. Efficacy of three-dimensional conformal radiotherapy for 132 patients with esophageal carcinoma[J].Zhonghua Fang She Zhong Liu Xue Za Zhi, 2009, 18 (1): 47-51. [蒋杰, 王奇峰,肖泽芬, 等. 132例食管癌三维适形 放疗的疗效分析[J]. 中华放射肿瘤学杂志, 2009, 18(1): 47-51.] [10] Wang YX, Zhu SC, Li J, et al. Three-dimensional conformal radiotherapy(3DCRT) for 209 patients with esophageal carcinoma[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2010, 19 (2): 101-4. [王玉祥, 祝淑钗, 李娟, 等. 209例食管癌三维适形 放疗疗效分析[J]. 中华放射肿瘤学杂志, 2010, 19(2): 101-4.]
计量
- 文章访问数: 1458
- HTML全文浏览量: 302
- PDF下载量: 742