食管癌钡餐造影结合CT近期疗效评价标准的临床应用研究

摘要

目的 探讨钡餐造影结合CT的食管癌放疗近期疗效评价标准的可行性及对预后的预测价值并提出改进意见,为临床提供依据.方法 2004-2015年月采用3DRT的529例食管癌患者,依据2013版钡餐造影结合CT评价标准进行近期疗效评价,并Kaplan-Meier法计算LC、生存率Logrank检验和并单因素预后分析.两种评价标准行Kappa一致性检验.结果 近期疗效评价标准对529例患者进行疗效界定并生存分析,完全缓解组(52例)与部分缓解组(409例)3、5、7、9年LC率分别为78.6％、69.8％、69.8％、63.4％与56.4％、47.9％、46.2％、42.4％;3、5、7、9年OS率分别为62.7％、49.1％、39.8％、39.8％与29.5％、21.6％、20.6％、19.5％,中位OS期分别为50个月与17个月(P=0.000),无缓解组(12例)中位OS期为5个月.放疗后CT测量残存淋巴结短径范围为0.37～3.40 cm(中位数0.82 cm),以短径0.5 cm为增幅将放疗后残存淋巴结短径逐一分组进行筛选,结果显示残存淋巴结短径≤1.00 cm组生存率高于短径＞1.00 cm组(P=0.000).以放疗后残存淋巴结短径1.00 cm代替原评价标准中的淋巴结体积1.00 cm3重新进行疗效评价,结果显示完全缓解组LC率及OS率仍优于部分缓解组(P=0.000、0.000).两种评价标准一致性较好(Kappa=0.863).结论 钡餐造影结合CT的近期疗效评价标准可以较为准确的判断食管癌近期疗效并评估预后;以放疗后CT测量残存淋巴结短径代替原标准中体积指标对疗效进行界定同样对预后有指导价值.%Objective To explore and improve the feasibility and prognostic value of barium radiography and computed tomography (CT)-based evaluation criteria in evaluation of the short-term efficacy of radiotherapy for esophageal cancer,and to provide a basis for clinical application.Methods The short-term treatment outcomes of 529 patients with esophageal carcinoma receiving three-dimensional radiotherapy from 2004 to 2015 were evaluated by the 2013 version of barium radiography and CT-based evaluation criteria.The local control (LC) and survival rates were calculated using the Kaplan-Meier method.The log-rank test was used for data analysis and univariate prognostic analysis.The agreement between two evaluation criteria was measured by the Kappa coefficient.Results According to the results of the survival analysis in all the patients using the evaluation criteria for short-term treatment outcomes,the 3-,5-,7-,and 9-year LC rates were 78.6％,69.8％,69.8％,and 63.4％ in the complete response (CR) group (n=52),and 56.4％,47.9％,46.2％,and 42.4％ in the partial response (PR) group (n=409),respectively;the 3-,5-,7-,and 9-year overall survival (OS) rates were 62.7％,49.1％,39.8％,and 39.8％ in the CR group,and 29.5％,21.6％,20.6％,and 19.5％ in the PR group,respectively;the median OS time was 50,17,and 5 months in the CR group,PR group,and non-response group (n=12),respectively (P=0.000).According to CT measurements,the short diameter of residual metastatic lymph node after radiotherapy was between 0.37-3.40 cm (median value=0.82 em).All patients were divided into groups based on the short diameter of residual metastatic lymph node after radiotherapy with a gradient of 0.5 cm.Patients with short diameters of residual metastatic lymph node of ≤ 1.00 cm had a significantly higher OS rate than those with short diameters of residual metastatic lymph node of＞ 1.00 cm (P =0.000).The lymph node volume of 1.00 cm3 in the original criteria was replaced by the short diameter of residual metastatic lymph node of 1.00 cm after radiotherapy and treatment outcomes were re-evaluated using the new criteria.The CR group still had significantly higher LC and OS rates than the PR group (P=0.000).There was a good agreement between the two evaluation criteria (Kappa =0.863).Conclusions The barium radiography and CT-based evaluation criteria for short-term treatment outcomes can accurately evaluate the short-term outcomes and predict prognosis in patients with esophageal carcinoma.Replacing the volume in the original criteria with the short diameter of residual metastatic lymph node after radiotherapy achieves similar results in prognostic prediction.