[食管癌大体肿瘤体积与淋巴结转移及预后的关系]

[Relationship of gross tumor volume with lymph node metastasis and prognosis of esophageal carcinoma].

作者信息

Xu Qian, Liu Zhi-kun, Cao Yan-kun, Li You-mei, Zhu Shu-chai

机构信息

Department of CT Imaging, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2012 Sep;34(9):684-7. doi: 10.3760/cma.j.issn.0253-3766.2012.09.009.

DOI:10.3760/cma.j.issn.0253-3766.2012.09.009

PMID:23159082

Abstract

OBJECTIVE

To explore whether there is a relationship between gross tumor volume (GTV) and pathologic lymph node metastasis or prognosis of esophageal carcinoma, and to provide a new prognosis reference for esophageal carcinoma (EC).

METHODS

Six hundred and seven patients received radical resection of thoracic esophageal carcinoma from May 2002 to June 2006 in our hospital, and their pre-operative CT images were transmitted to the three-dimensional conformal radiotherapy planning system by the network in digital format. Esophageal GTV targets were outlined and their GTV volumes were calculated. To analyze whether there is a relationship between GTV volume and pathologic lymph node metastasis or prognosis.

RESULTS

In the 607 cases of esophageal carcinoma, the GTV volume was (22.5 ± 16.8) cm(3) in 374 stage N0 EC patients, significantly different from that of (30.4 ± 20.1) cm(3) in 233 stage N1 EC cases (P < 0.001). There is a significant difference between the GTV volumes of the groups with and without lymph node metastasis (P < 0.05). There was a significant difference of the GTV volumes of EC patients with one lymph node metastasis and those with ≥ 4 lymph node metastasis (P < 0.05). There was a positive correlation between GTV volume and the number of lymph node metastasis (r = 0.230, P < 0.001). The 1-, 3-, 5-year survival rates since the surgery date were 83.8%, 53.5%, and 36.4%, respectively. There was a significant difference between the survival rates of stage N0 (48.5%) and stage N1 patients (18.2%, P < 0.001), and there was a significant difference between the survival rats of patients with 0, 1 and ≥ 2 lymph node metastasis (P < 0.01). Cox regression model analysis showed that GTV volume, number of lymph node metastasis, pathological type, and lesion site were independent prognostic factors (all P < 0.05).

CONCLUSION

The GTV volume of esophageal carcinoma is positively correlated with the number of pathologic lymph node metastasis, and it is an independent prognostic factor for this cancer.

摘要

目的

探讨食管癌大体肿瘤体积（GTV）与病理淋巴结转移及预后之间是否存在关系，为食管癌（EC）提供新的预后参考。

方法

2002年5月至2006年6月我院607例行胸段食管癌根治性切除术的患者，其术前CT图像通过网络以数字格式传输至三维适形放疗计划系统。勾勒出食管GTV靶区并计算其GTV体积。分析GTV体积与病理淋巴结转移及预后之间是否存在关系。

结果

在607例食管癌患者中，374例N0期EC患者的GTV体积为（22.5±16.8）cm³，与233例N1期EC患者的（30.4±20.1）cm³有显著差异（P<0.001）。有、无淋巴结转移组的GTV体积有显著差异（P<0.05）。有1个淋巴结转移的EC患者与有≥4个淋巴结转移的患者的GTV体积有显著差异（P<0.05）。GTV体积与淋巴结转移数量呈正相关（r=0.230，P<0.001）。自手术日期起1年、3年、5年生存率分别为83.8%、53.5%和36.4%。N0期（48.5%）和N1期患者的生存率有显著差异（18.2%，P<0.001），0个、1个和≥2个淋巴结转移患者的生存率有显著差异（P<0.01）。Cox回归模型分析显示，GTV体积、淋巴结转移数量、病理类型和病变部位是独立的预后因素（均P<0.05）。