摘要目的 参考中国非手术治疗食管癌临床分期修改方案对784例食管癌三维适形放疗患者进行预后分析与评价,探讨此分期对食管癌非手术治疗预后的预测价值及有待修改之处.方法 2003-2009年间784例食管癌患者接受常规分割技术,处方剂量50～70 Gy.＜60 Gy者65例,≥60Gy者719例.鳞癌患者752例,非鳞癌患者32例.依据临床分期标准将患者分为各亚组,观察其疗效并进行预后评价.结果 随访率为97.1％,随访时间满3、5年者分别为503、122例.全组1、3、5年局部控制率分别为77.2％、54.2％、46.5％,总生存率分别为69.5％、34.9％、23.9％.Ⅰ,Ⅱ和Ⅲ期患者1、3、5年生存率分别为86.4％、47.6％、45.1％,84.7％、46.3％、36.4％和64.0％、30.9％、19.1％,(x2=29.34,P=0.000).鳞癌和非鳞癌患者中位生存期不同(21个月和16个月,x2=4.44,P=0.035).GTV≤20、20～40、40 ～ 60 cm3与＞ 60 cm3患者中位生存期也不同(54、29、21个月和14个月,x2 =68.71,P=0.000).结论 非手术治疗食管癌临床分期修改方案能较为准确反应食管癌放疗患者预后;不同病理类型及GTV患者预后存在差异,建议分期修改方案纳入病理类型及GTV因素.

abstractsObjective To analyze the prognosis of 784 patients according with clinical staging of esophageal carcinoma treated with non-surgical methods,investigate the predictive value and deficiency of the clinical staging.Methods From July 2003 to January 2009,784 patients with esophageal carcinoma received 3DCRT treatment.The prescribed doses ranged from 50 Gy-70 Gy with median dose of 60 Gy,1.8-2.0 Gy/fraction,1 fraction/day,5 fractions/week.65 patients received prescription dose of＜60 Gy and all the others'≥60 Gy.All the patients were divided into subgroups according to different T,N and TNM stages.Therapeutic effect was evaluated.Results The follow up rate was 97.1％,503 patients were followed up for more than 3 years and 122 were followed up for more than 5 years.The 1-,3-,5-year local control rates and overall survival rates were 77.2％,54.2％,46.5％ and 69.5％,34.9％,23.9％,respectively,with median survival time of 21 months.There were significant differences of survival curves for different T stages,N stages and TNM stages.For the groups of stage Ⅰ,Ⅱ and Ⅲ,the 1-,3-,5-year survival rates were 86.4％,47.6％,45.1％ ;84.7％,46.3％,36.4％ and 64.0％,30.9％,19.1％,respectively ( x2 =29.34,P =0.000).There were 752 patients with squamous cell carcinoma ( 95.9％ )and 32 patients with non-squamous cell carcinoma (4.1％ ),the median survival time were 21 and 16 months,respectively ( x2 =4.44,P =0.035 ).There were significant difference of survival rates for the subgroups whose GTV volume ≤20 cm3,20 -40 cm3,40 -60 cm3 and ＞60 cm3 (54 months,29 months,21months and 14months,x2 =68.71,P =0.000).Conclusions The clinical staging of esophageal carcinoma treated with non-surgical methods could predict the prognosis accurately,for patients with different pathology and GTV volumes,there were variance in the prognosis,so we advised the complement of the two factors in the draft of clinical stages.