孙荣刚 刘锐 于明艳

【摘要】 目的：探讨非手术食管癌CT临床分期方法试用情况。方法：收集2014年1月-2017年8月本院放疗科收治的非手术食管癌放疗患者，基于胸部CT设计新的临床分期，通过生存分析验证其适用性。结果：112例老年食管癌患者1、2、3、4年总生存率分别是54%、34%、30%、28%。按照新的方法检验生存率，T分期：T0、T1两组生存曲线分开较好，但差异无统计学意义（字2=2.614，P=0.106）。N分期：N0、N1、N2三组生存率比较，差异均有统计学意义（字2=11.639，P=0.003）。新的临床分期：Ⅰ期、Ⅱ期、Ⅲ期三组生存曲线分离明显，差异均有统计学意义（字2=16.198，P=0.000）。结论：基于胸部CT新的临床分期能较好地判断预后，值得进一步研究。

【关键词】 老年患者; 食管癌; 临床分期; 预后

【Abstract】 Objective：To explore the clinical staging of non-surgical esophageal cancer by CT.Method：Non-surgical patients with esophageal cancer who were admitted to the Radiotherapy Department of our hospital from January 2014 to August 2017 were collected.Designed a new clinical stage based on chest CT and validated its applicability through survival analysis.Result：The1，2，3，4 year over all survival rate of 112 elderly patients with esophageal cancer was 54%，34%，30% and 28%.Survival rate was tested according to new method，T stage：the survival curves of T0 and T1 group were well separated，but the differences wasno statistically significant（字2=2.614，P=0.106）.N stage：the survival rate of N0，N1，N2 group were compared，the differences were statistically significant（字2=11.639，P=0.003）.The new clinical stage：the survival curves of the stage Ⅰ，stage Ⅱ and stage Ⅲ group were significantly separated，the differences were statistically significant（字2=16.198，P=0.000）.Conclusion：The new clinical staging based on chest CT can better judge the prognosis and deserves further study.

【Key words】 Elderly patients; Esophageal cancer; Clinical stage; Prognosis

First-authors address：Yangzhong Peoples Hospital，Yangzhong 212200，China

doi：10.3969/j.issn.1674-4985.2019.16.036

食管癌是我國最常见的恶性肿瘤之一，发现80%就诊者为中晚期，放射治疗是中晚期患者的主要治疗手段，同期放化疗则是可耐受患者的标准治疗方式。由于目前食管癌的国际分期是基于术后患者制定，因此对于非手术患者的临床分期是目前的难点，目前并没有合适的临床分期指导非手术食管癌患者的治疗。本研究回顾了本院放疗科120例食管癌放射治疗患者的临床资料，基于CT表现，整合现有的临床预后因素，并加以生存检验，现报道如下。

1 资料与方法

1.1 一般资料 回顾性分析2014年1月-2017年8月本院放疗科收治的120例70岁以上老年食管癌患者的临床资料，经医院伦理委员会通过，开展非手术食管癌患者基于胸部CT新的临床分期方法的研究。纳入标准：病理证实均为鳞癌;影像检查排除远处转移者;不能手术或拒绝手术患者。……