Chak A, Canto M, Gerdes H, Lightdale C J, Hawes R H, Wiersema M J, Kallimanis G, Tio T L, Rice T W, Boyce H W
Division of Gastroenterology, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106-5066, USA.
Gastrointest Endosc. 1995 Dec;42(6):501-6. doi: 10.1016/s0016-5107(95)70001-3.
Endosonography is a significant advance in the preoperative staging (TNM classification) of esophageal cancer. Its accuracy for evaluating depth of tumor invasion is over 80%.
A multicenter retrospective cohort study of patients with esophageal carcinomas defined to be invasive (T4) by endosonography was performed to compare the survival of surgically and nonsurgically treated patients. Median survival time, overall mortality, and Kaplan-Meier survival curves were compared by treatment group. Univariate and Cox regression analysis were used to evaluate the effects of various prognostic factors and treatment on the risk of death.
A total of 79 patients were studied. The surgical group (Group I, n = 42) was significantly younger and had more distal tumors (adenocarcinomas) than the nonsurgical group (Group II, n = 37). Endosonography was significantly more accurate than CT scanning in identifying tumor invasion (87.5% versus 43.8%, respectively, p = .0002). Overall mortality rate was not significantly different between treatment groups; 59.5% of the surgical group and 64.9% of the nonsurgical group were dead at follow-up (p = 0.65). Similarly, the median survival times of Group I and Group II patients were similar (5.2 and 7.0 months, respectively, p = 0.50). Survival curves for the two groups were almost overlapping (log rank test, p = 0.84). Even after adjusting for age, histologic diagnosis, tumor location, and regional lymph node status, surgical treatment did not significantly influence survival (p = 0.24).
Endosonography accurately identifies patients with invasive T4 tumors who have a poor prognosis. This prognosis is independent of mode of therapy.
内镜超声检查是食管癌术前分期（TNM 分类）的一项重大进展。其评估肿瘤浸润深度的准确率超过 80%。
对经内镜超声检查确定为浸润性（T4）食管癌患者进行多中心回顾性队列研究，比较手术治疗和非手术治疗患者的生存率。通过治疗组比较中位生存时间、总死亡率和 Kaplan-Meier 生存曲线。采用单因素和 Cox 回归分析评估各种预后因素和治疗对死亡风险的影响。
共研究了 79 例患者。手术组（I 组，n = 42）比非手术组（II 组，n = 37）明显年轻，且远端肿瘤（腺癌）更多。在内镜超声检查识别肿瘤浸润方面明显比 CT 扫描更准确（分别为 87.5%对 43.8%，p = 0.0002）。治疗组之间的总死亡率无显著差异；随访时手术组 59.5%和非手术组 64.9%死亡（p = 0.65）。同样，I 组和 II 组患者的中位生存时间相似（分别为 5.2 个月和 7.0 个月，p = 0.50）。两组的生存曲线几乎重叠（对数秩检验，p = 0.84）。即使在调整年龄、组织学诊断、肿瘤位置和区域淋巴结状态后，手术治疗对生存率也没有显著影响（p = 0.24）。
内镜超声检查能准确识别预后不良的浸润性 T4 肿瘤患者。这种预后与治疗方式无关。
