Correlation between GTV-T Volume, Clinical Stage and Prognosis of Esophageal Carcinoma Patients Treated with Three-dimensional Conformal Radiotherapy
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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.
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Key words:
- GTV-T volume /
- Clinical stage /
- Esophageal carcinoma /
- Prognosis
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