CAJ | 학술논문

目的探讨有腔内超声(EUS)参与的非手术食管癌临床分期的实用性以及对预后的预测价值.方法搜集本院2003-2012年间非手术治疗的290例食管鳞癌患者资料.结合EUS、CT检查按2002年UICC分期标准对全组患者进行临床分期,并分析各期别间患者的生存率及预后因素.Kaplan-Meier法计算生存率并Logrank检验,采用Cox法进行多因素分析.结果 EUS完全通过并能有效T、N分期者178例,其中T1～T4期的OS差异无统计学意义(P =0.247),N0期的OS、PFS差异均有统计学意义(P=0.000、0.006),N0与N1期的OS、PFS差异也均有统计学意义(P=0.012、0.016).EUS不能通过者112例,较能通过者的OS、PFS差(P=0.001、0.003).CT的T分期和N分期对OS、PFS均有影响(P=0.004、0.030和P=0.024、0.020).全组1、3、5年样本数分别为290、174、73例,全组1、3、5年OS分别为61.7％、27.8％、19.8％.2002 UICC临床分期各期别间OS、PFS差异均有统计学意义(P =0.000、0.000).多因素分析显示性别、年龄、临床分期是总生存的影响因素(P =0.004、0.020、0.002).结论有EUS参与的食管癌临床分期能预测非手术治疗患者的预后,建议将EUS作为我国食管癌疗前分期检查的基本手段.
목적 탐토유강내초성(EUS)삼여적비수술식관암림상분기적실용성이급대예후적예측개치.방법 수집본원2003-2012년간비수술치료적290례식관린암환자자료.결합EUS、CT검사안2002년UICC분기표준대전조환자진행림상분기,병분석각기별간환자적생존솔급예후인소.Kaplan-Meier법계산생존솔병Logrank검험,채용Cox법진행다인소분석.결과 EUS완전통과병능유효T、N분기자178례,기중T1～T4기적OS차이무통계학의의(P =0.247),N0기적OS、PFS차이균유통계학의의(P=0.000、0.006),N0여N1기적OS、PFS차이야균유통계학의의(P=0.012、0.016).EUS불능통과자112례,교능통과자적OS、PFS차(P=0.001、0.003).CT적T분기화N분기대OS、PFS균유영향(P=0.004、0.030화P=0.024、0.020).전조1、3、5년양본수분별위290、174、73례,전조1、3、5년OS분별위61.7％、27.8％、19.8％.2002 UICC림상분기각기별간OS、PFS차이균유통계학의의(P =0.000、0.000).다인소분석현시성별、년령、림상분기시총생존적영향인소(P =0.004、0.020、0.002).결론 유EUS삼여적식관암림상분기능예측비수술치료환자적예후,건의장EUS작위아국식관암료전분기검사적기본수단.
Objective To investigate the clinical staging of non-surgically treated esophageal cancer based on endoscopic ultrasonography (EUS) and computed tomography (CT) and its prognostic value.Methods A total of 290 patients with esophageal squamous cell carcinoma who received non-surgical treatment in our hospital from November 2003 to March 2012 were retrospectively reviewed.The clinical stage of each patient was evaluated based on EUS and CT according to the 2002 UICC TNM staging system.The survival rates and prognostic factors for patients of different stages were analyzed.The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for survival difference analysis; the multivariate analysis was performed using the Cox model.Results EUS could be completely performed in 178(61.4％) of all patients,and their EUS T and N stages were determined.There were no significant differences in overall survival (OS) between patients with EUS T1-T4 diseases (P =0.247) ; there were significant differences in OS and progression-free survival (PFS) between individuals of different EUS T stages among patients with EUS N0 disease (P =0.000; P =0.006).OS and PFS also showed significant differences between patients with N0 and N1 diseases (P =0.012;P =0.016).EUS could not be completely performed in 112 patients,who had poorer OS and PFS than other patients (P =0.001 ;P =0.003).CT T and N stages also affected OS and PFS (OS P =0.004,PFS P =0.030 ; OS P =0.024,PFS P =0.020).The 1-,3-,and 5-year sample sizes were 290,174,and 73,respectively.The 1-,3-,and 5-year OS rates for all patients were 61.7％,27.8％,and 19.8％,respectively.OS and PFS varied significantly between patients of different 2002 UICC clinical stages (P =0.000 and 0.000).The multivariate analysis showed that sex,age and clinical stage were independent prognostic factors (P =0.004,0.020,and 0.002).Conclusions The clinical staging based on EUS and CT can predict the survival in esophageal cancer patients treated with non-surgical method.EUS is recommended as a basic means for pretreatment staging of esophageal cancer in China.