| Objective: The non-surgical treatment of patients with esophagealcarcinoma were staged with three clinical staging standards including stagingstandard in2004edited, staging standard in2009edited and GTV-T (GrossTumor Volume-Tumor) clinical staging standard. Selected an appropriateGTV-T staging standard, then staged all patients according to T staging as wellas lymph node metastasis. In order to determine a more reasonable clinicalstaging standard of the non-surgical treatment esophageal carcinoma, weobserved the prognosis of patients with the four different staging standards.Methods: From January2005to December2010,219eligible patientswith esophageal carcinoma were included in this study. We maderetrospectively analysis of clinical data of the219patients. Beforeradiotherapy all patients needed the examinations including esophagealbarium meal and positioning CT scan which was transferred to the radiationtreatment planning system, then we outlined the target vange and calculatedthe volume of GTV-T. All the patients were clinical staged in accordance withstaging standard in2004, staging standard in2009and GTV-T clinical stagingstandard. Selected a appropriate GTV-T staging standard combined with thelymph node metastasis as the new staging standard for all patients. Theshort-term effects by esophageal barium meal were evaluated after a month ofradiotherapy. SPSS13.0statistical package was used to take statisticallyanalysis.Results:(1) Follow-up: Follow-up was from date of the start ofradiotherapy and ended at December31,2012. Follow-up time was from2to82months (the median was23months) and the rate of follow-up was96.3%.(2) Survival analysis of all patients: The survival rates of1-year,3-years and5-years of the whole group were70.8%,35.6%and20.7%respectively, andlocal control rates of1-year,3-years and5-years were66.9%,46.4%,40.5% respectively. Median time of survival was23months and median time of localcontrol was28months. The three esophageal carcinoma clinical stagingstandards adopted the same N staging standard. The separation of survivalcurve was better when N1and N2was combined, and the survival differencewas statistically significant (χ2＝6.308, P=0.012). All the three esophagealcarcinoma clinical staging standards could reflect prognosis of patients treatedby radiotherapy.(3) Improved GTV-T volume staging: While divided theGTV-T volume into four grades (T1～T4) according to≤12cm3,12～65cm3,65～120cm3and＞120cm3, the separation of survival curves was well but thedifference between T3and T4no statistically significant (χ2＝3.258, P=0.071).While the GTV-T volume was divided into three grades (T1, T2, T3+4), theseparation of the survival curve was better and the difference of survival wasstatistically significant (χ2＝16.090, P=0.000). N staging and TNM stagingwith improved GTV-T staging standard were the same as staging standard2009edited. When all the patients were staged by improved GTV-T staging,the separation of TNM staging survival curves was good and the difference ofsurvival was statistically significant (χ2＝20.114, P=0.000).(4) Correlationanalysis of clinical staging: Improved GTV-T volume staging standard wassignificantly correlated with the othe three clinical staging standards in Tstaging (P=0.000). Improved GTV-T volume staging standard wassignificantly correlated with the othe three clinical staging standards in TNMstaging and had more significant correlation with GTV-T clinical stagingstandard (r=0.754, P=0.000).(5) Consistency analysis of clinical staging:Improved GTV-T volume clinical staging standard had significantlyconsistency with the othe three clinical staging standards in T staging(P=0.000). Improved GTV-T volume clinical staging standard was lessconsistent with clinical staging standard2004edited in TNM staging(Kappa=0.099，P=0.002) and improved GTV-T volume staging was muchearlier. Improved GTV-T volume clinical staging standard was moreconsistent with clinical staging standard2009edited in TNM staging(Kappa=0.37，P=0.000). Improved GTV-T volume clinical staging standard was generally consistent with GTV-T volume clinical staging standard inTNM staging (Kappa=0.152, P=0.000) and improved GTV-T volume stagingwas little earlier.(6) The short-term effect: The short-term effects of allpatients after radiotherapy were CR30.1%(66/219)，PR69.0%(151/219) andNR0.9%(2/219). The total effective rate (CR+PR) was99.1%. Patients wereevaluated for CR and PR had better prognosis than NR and the difference wasstatistically significant (χ2＝124.265, P=0.000).(7) Prognostic factors analysisof esophageal carcinoma: The univariate analysis of the prognosis was doneby tumor length, the maximum diameter of the tumor showed on CT scan,GTV-T volume, clinical T staging, clinical N staging, clinical TNM staging,the target range, short-term effect, chemotherapy cycle, recurrence and distantmetastasis after treatment. The multivariate analysis including clinical TNMstaging2009edited, local or/regional recurrence and distant metastasis aftertreatment were proved influencing the prognosis.(8) The state of the death:There was a total of155cases of death in the whole group (70.8%), in which85cases (54.8%) died of local recurrence or uncontrolled,(1case died ofrecurrence of regional lymph node,10cases died of the esophageal bleedingand12cases died of esophageal fistula),30cases died of distant metastasis(19.4%),4cases died of local recurrence as well as distant metastasis (2.6%),36cases (23.2%) died of other causes (11cases died of systemic failure,7cases died of pneumonia,1case died of radiation pneumonitisand,7casesdied of heart disease,2cases died of brain hemorrhage and8cases withunknown cause of death).Conclusion:1. All of the four esophageal carcinoma clinical stagingstandards could reflect the prognosis of patients treated with radiotherapy, andthe clinical staging standard2009edited seemed better than others.2.Improved GTV-T clinical staging standard could accurately predict theprognosis of patients after radiotherapy, in addition this standard was easy tooperate.3. TNM staging2009edited, local or/and regional recurrence anddistant metastasis after radiotherapy were proved as the independentprognostic factors. |
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