Fockens P, Kisman K, Merkus M P, van Lanschot J J, Obertop H, Tytgat G N
Department of Gastroenterology, University of Amsterdam, The Netherlands.
J Am Coll Surg. 1998 Jan;186(1):17-23. doi: 10.1016/s1072-7515(97)00131-2.
Endosonography is an accurate preoperative staging technique for esophageal carcinoma. We retrospectively investigated a cohort of patients with carcinoma of the esophagus or gastric cardia that was endosonographically staged to be irresectable and studied whether their survival was influenced by the treatment received.
Between April 1992 and July 1995, 654 patients were referred for endosonographic staging. We retrospectively searched our database for patients staged T4 and collected followup. Kaplan-Meier survival and Cox proportional hazards model were used to study the effect of treatment and various other factors on survival.
Fifty-one patients (median age, 62 years; range, 44-87; 37 male) were staged T4 by endosonography. Followup was collected of all patients. Explorative surgery was chosen in 24 patients (47%), and the tumor was resected in 13 patients. Median survival in the surgical group was 9.67 months (95% confidence interval [CI] 6.03, 13.31) and 7.06 months (95% CI: 5.68, 8.44) in the nonsurgical group (not significant). Patients with infiltration in the respiratory tract had a 2.5 times higher risk of death than patients without (adjusted hazard ratio: 2.54; 95% CI: 1.30, 4.96).
Patients staged irresectable by endosonography (T4 stage) have a very poor prognosis, regardless of further therapy. Survival of this group of patients was not influenced by surgery.
内镜超声检查是一种用于食管癌的准确术前分期技术。我们回顾性研究了一组经内镜超声检查分期为不可切除的食管癌或贲门癌患者，并研究了他们所接受的治疗是否会影响其生存。
在1992年4月至1995年7月期间，654例患者被转诊进行内镜超声检查分期。我们回顾性地在数据库中搜索分期为T4的患者并收集随访信息。采用Kaplan-Meier生存分析和Cox比例风险模型来研究治疗及其他各种因素对生存的影响。
51例患者（中位年龄62岁；范围44 - 87岁；37例男性）经内镜超声检查分期为T4。收集了所有患者的随访信息。24例患者（47%）选择了探查性手术，其中13例患者肿瘤被切除。手术组的中位生存期为9.67个月（95%置信区间[CI] 6.03, 13.31），非手术组为7.06个月（95% CI：5.68, 8.44）（无显著差异）。呼吸道受浸润的患者死亡风险比未受浸润的患者高2.5倍（调整后的风险比：2.54；95% CI：1.30, 4.96）。
经内镜超声检查分期为不可切除（T4期）的患者预后非常差，无论是否接受进一步治疗。这组患者的生存不受手术影响。
