超声内镜检查评估T3期食管鳞癌的准确性研究

Accuracy of endoscopic ultrasonography for evaluating T3 esophageal squamous cell carcinoma

    摘要
  • 摘要: 目的:探讨EUS检查评估T3期食管鳞癌的准确性。
    方法:采用回顾性横断面研究方法。收集2003年1月至2015年12月中山大学肿瘤防治中心收治的733例术前经EUS检查评估为T3期食管鳞癌患者的临床病理资料。733例患者均行食管癌根治术，以术后病理学检查分期为金标准，评价术前EUS检查评估临床分期的准确率、过高分期率和过低分期率。观察指标：(1)术前EUS检查评估临床T分期与术后病理学T分期的比较。(2)随访和术后生存情况。术后采用门诊或电话方式进行随访。记录患者疾病及生存情况。患者总体生存时间定义为从手术时间至患者死亡或最后1次有效随访时间。随访时间截至2016年12月30日。正态分布的计量资料以±s表示，偏态分布的计量资料以M(范围)表示，计数资料以例数和百分比表示。采用KaplanMeier法绘制生存曲线，生存分析采用Logrank检验。
    结果:(1)术前EUS检查评估临床T分期与术后病理学T分期的比较：733例食管鳞癌患者术前EUS检查均评估为T3期。733例食管鳞癌患者经术后病理学检查诊断：pT1b期9例，pT2期87例，pT3期630例，pT4a期 7例。术前EUS检查评估准确率为85.95%(630/733)，过高分期率为13.10%(96/733)，过低分期率为0.95%(7/733)。术后病理学N分期：N0、N1、N2、N3期患者例数分别为329、247、110、47例；TNM分期：Ⅰ、Ⅱ、Ⅲ期患者例数分别为27、323、383例；分化程度：高分化、中分化、低分化肿瘤患者数分别125、403、205例。(2)随访和术后生存情况：733例患者中，639例患者获得术后随访，随访时间为1.0～153.0个月，中位随访时间为29.0个月。733例患者中位生存时间为53.0个月(37.7～68.3个月)，1、3、5年总体生存率分别为85.3%、58.1%、48.2%。不同术后病理学T分期患者的生存分析：9例pT1b期、87例pT2期、 630例pT3期、7例pT4a期食管鳞癌患者术后5年总体生存率为75.2%、63.0%、46.3%、0，4者预后比较，差异有统计学意义(x2=24.089，P<0.05)。
    结论:EUS检查对食管鳞癌T分期评估具有较高的准确性，但仍有部分患者临床分期上移。

     

    Abstract: Objective:To explore the accuracy of endoscopic ultrasonography (EUS) for evaluating T3 esophageal squamous cell carcinoma (ESCC).
    Methods:The retrospective crosssectional study was conducted. The clinicopathological data of 733 patients diagnosed with T3 ESCC by preoperative EUS who were admitted to the Sun Yatsen University Cancer Center from January 2003 to December 2015 were collected. All the patients underwent radical resection of ESCC. The postoperative pathological stage as a gold standard, the accuracy, overstaged and understaged rates of clinical staging by preoperative EUS were assessed. Observation indicators: (1) comparison between clinical T staging evaluated by preoperative EUS and postoperative pathological T staging; (2) followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect patients′ diseases and postoperative survival up to December 30, 2016. Overall survival time was from operation time to death or last effective followup. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Count data were represented as cases and percentage. The survival curve was drawn by the KaplanMeier method, and survival analysis was done using the Logrank test.
    Results:(1) Comparison between clinical T staging evaluated by preoperative EUS and postoperative pathological T staging: all the 733 patients were confirmed as T3 ESCC by preoperative EUS. Postoperative pathological diagnosis showed that 9 patients were detected in pT1b, 87 in pT2, 630 in pT3 and 7 in pT4a. The accuracy, overstaged and understaged rates of preoperative EUS in evaluating T3 ESCC were 85.95%(630/733), 13.10%(96/733) and 0.95%(7/733), respectively. N0, N1, N2 and N3 of postoperative pathological N stage were respectively detected in 329, 247, 110 and 47 patients. Twentyseven, 323 and 383 patients were in stageⅠ, Ⅱ and Ⅲ of TNM stage, respectively. The high, moderate and lowdifferentiated tumors were respectively detected in 125, 403 and 205 patients. (2) Followup and survival situations: among 733 patients, 639 were followed up for 1.0-153.0 months, with a median time of 29.0 months. The median survival time, 1, 3, 5year overall survival rates were 53.0 months (range, 37.7-68.3 months), 85.3%, 58.1% and 48.2% in 733 patients, respectively. The 5year overall survival rate was 75.2% in 9 patients with pT1b, 63.0% in 87 patients with pT2, 46.3% in 630 patients with pT3 and 0 in 7 patients with pT4a, respectively, with a statistically significant difference (x2=24.089, P<0.05).
    Conclusion:There is a higher accuracy of EUS for evaluating T3 ESCC, however, the stage migration should be noted.

     

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