基于肿瘤分期的可切除食管鳞状细胞癌CT测量的大体肿瘤体积：与食管切除术后早期复发的关联
Tumor Stage-Based Gross Tumor Volume of Resectable Esophageal Squamous Cell Carcinoma Measured on CT: Association With Early Recurrence After Esophagectomy.
作者信息
Wu Yu-Ping, Tang Sun, Tan Bang-Guo, Yang Li-Qin, Lu Fu-Lin, Chen Tian-Wu, Ou Jing, Zhang Xiao-Ming, Gao Dan, Li Ke-Ying, Yu Zi-Yi, Tang Zhao
机构信息
Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
出版信息
Front Oncol. 2021 Oct 22;11:753797. doi: 10.3389/fonc.2021.753797. eCollection 2021.
OBJECTIVE
To investigate relationship of tumor stage-based gross tumor volume (GTV) of esophageal squamous cell carcinoma (ESCC) measured on computed tomography (CT) with early recurrence (ER) after esophagectomy.
MATERIALS AND METHODS
Two hundred and four consecutive patients with resectable ESCC including 159 patients enrolled in the training cohort (TC) and 45 patients in validation cohort (VC) underwent contrast-enhanced CT less than 2 weeks before esophagectomy. GTV was retrospectively measured by multiplying sums of all tumor areas by section thickness. For the TC, univariate and multivariate analyses were performed to determine factors associated with ER. Mann-Whitney U test was conducted to compare GTV in patients with and without ER. Receiver operating characteristic (ROC) analysis was performed to determine if tumor stage-based GTV could predict ER. For the VC, unweighted Cohen's Kappa tests were used to evaluate the performances of the previous ROC predictive models.
RESULTS
ER occurred in 63 of 159 patients (39.6%) in the TC. According to the univariate analysis, histologic differentiation, cT stage, cN stage, and GTV were associated with ER after esophagectomy (all -values < 0.05). Multivariate analysis revealed that cT stage and GTV were independent risk factors with hazard ratios of 3.382 [95% confidence interval (CI): 1.533-7.459] and 1.222 (95% CI: 1.125-1.327), respectively (all -values < 0.05). Mann-Whitney U tests showed that GTV could help differentiate between ESCC with and without ER in stages cT, cT, and cT (all -values < 0.001), and the ROC analysis demonstrated the corresponding cutoffs of 13.31, 17.22, and 17.83 cm with areas under the curve of more than 0.8, respectively. In the VC, the Kappa tests validated that the ROC predictive models had good performances for differentiating between ESCC with and without ER in stages cT, cT, and cT with Cohen k of 0.696 (95% CI, 0.498-0.894), 0.733 (95% CI, 0.386-1.080), and 0.862 (95% CI, 0.603-1.121), respectively.
CONCLUSION
GTV and cT stage can be independent risk factors of ER in ESCC after esophagectomy, and tumor stage-based GTV measured on CT can help predict ER.
目的
探讨基于肿瘤分期的食管鳞状细胞癌（ESCC）在计算机断层扫描（CT）上测量的大体肿瘤体积（GTV）与食管切除术后早期复发（ER）的关系。
材料与方法
204例连续的可切除ESCC患者，其中159例纳入训练队列（TC），45例纳入验证队列（VC），在食管切除术前不到2周接受增强CT检查。GTV通过将所有肿瘤区域的总和乘以切片厚度进行回顾性测量。对于TC，进行单因素和多因素分析以确定与ER相关的因素。进行Mann-Whitney U检验以比较有和无ER患者的GTV。进行受试者操作特征（ROC）分析以确定基于肿瘤分期的GTV是否可以预测ER。对于VC，使用未加权的Cohen's Kappa检验评估先前ROC预测模型的性能。
结果
TC中159例患者中有63例（39.6%）发生ER。根据单因素分析，组织学分化、cT分期、cN分期和GTV与食管切除术后的ER相关（所有P值<0.05）。多因素分析显示，cT分期和GTV是独立危险因素，风险比分别为3.382[95%置信区间（CI）：1.533 - 7.459]和1.222（95%CI：1.125 - 1.327）（所有P值<0.05）。Mann-Whitney U检验表明，GTV有助于区分cT、cT和cT期有和无ER的ESCC（所有P值<0.001），ROC分析显示相应的截断值分别为13.31、17.22和17.83 cm，曲线下面积均大于0.8。在VC中，Kappa检验验证了ROC预测模型在区分cT、cT和cT期有和无ER的ESCC方面具有良好性能，Cohen k分别为0.696（95%CI，0.498 - 0.894）、0.733（95%CI，0.386 - 1.080）和0.862（95%CI，0.603 - 1.121）。
结论
GTV和cT分期可以是食管切除术后ESCC中ER的独立危险因素，并且在CT上测量的基于肿瘤分期的GTV可以帮助预测ER。
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