| Objective 1,To verify the draft Chinese staging system of esophageal carcinoma in non-surgical treatment setting (named as Shijiazhuang Protocol in this article) with a cohort of patients treated by three-dimension conformal radiotherapy (3DCRT) and maturely followed-up. 2,To explore the alternative staging protocol for esophageal primary tumor with volumetric features of CT image. 3,To explore other standards for the staging of lymph node.Methods Two hundred and thirty four patients of esophageal carcinoma treated by 3DCRT in Cancer Hospital of Shantou University Medical College from Jan 2005 to Dec 2006 were collected for this study. Section 1: All cases were staged according to Shijiazhuang Protocol on T, N and clinical stage. The distribution of patient in each stage and the stage depended survival results were analyzed. Section 2: The gross tumor volume (GTV) of esophageal primary lesion was contoured in treatment planning system for all cases. The total volume, maximum anterior-posterior dimension (AP dimension), maximum lateral dimension (LT dimension) and maximum extension of infiltration (Thickness) of GTV were measured. The patients were divided into three groups of T stage by the above mentioned features of GTV with various criteria. The proportions and survival results of each T group were further evaluated. Section 3: The total number of metastatic lymph nodes or the number of involved lymphatic drainage regions were taken as staging factors to restage the regional LN. The proportions and survival results of different stage were studied.Results Section 1: The median survival time of all cases was 19.2 month. The 1-year, 3-year and 5-year overall survival rates were 71.8%,33.3% and 26.3%, respectively. The number of T1, T2, T3, and T4 were 5, 50, 45 and 134, and the 1-year survival rates were 100%, 82.0%, 84.0% and 62.8%; the 3-year survival rates were 100%, 41.3%, 32.9% and 27.6%; the 5-year survival rates were 100%, 35.9%, 24.9% and 19.7% respectively(P=0.004). The separated survival curves showed reasonable result. The number of N0, N1 and N2 were 80, 26 and 128, and the 1-year survival rates were 75.9%, 79.8% and 67.6%; the 3-year survival rates were 41.8%, 25.8% and 29.1%; the 5-year survival rates were 34.7%, 15.5% and 22.8% respectively(P=0.069). The survival curves of N1 and N2 were crossed. The number of stage I,Ⅱ,Ⅲwere 29, 18 and 187, and the 1-year survival rates were 82.8%, 88.2% and 68.5%; the 3-year survival rates were 54.6%, 20.2% and 31.0%; the 5-year survival rates were 50.7%, 0% and 23.7% respectively(P=0.028). The survival curves of stageⅡand stageⅢwere crossed as well. When defined the para-esophagi-trachea lymph nodes in the supraclavicular area with maximum dimension≥5mm but <10mm as N1 , the 1-year survival rates of N0, N1,N2 after revised were 75.9%, 75.8% and 66.2%; the 3-year survival rates were 41.8%, 34.7% and 25.6%; the 5-year survival rates were 34.7%, 27.1% and 19.0% respectively(P=0.024). The separated survival curves showed reasonable result. The 1-year survival rates of stage I,Ⅱ,Ⅲafter revised were 82.8%, 84.4% and 67.5%; the 3-year survival rates were 54.6%, 34.0% and 29.4%; the 5-year survival rates were 50.7%, 28.3% and 21.6% respectively(P=0.012). The separated survival curves also showed reasonable result.Section 2: When divided the patients into three groups by the total volume of GTV of≤20cm3, 20～40cm3 and﹥40cm3, the proportions of each group were 32.5%, 36.3% and 31.3% respectively, and the 1-year survival rates were 85.5%, 70.2% and 58.8%; the 3-year survival rates were 48.6%, 31.1% and 19.2%; the 5-year survival rates were 39.9%, 23.5% and 15.1% respectively(P=0.000). The separated survival curves of these three groups showed reasonable result. When divided the patients into three groups by maximum AP dimension of GTV of≤2cm, 2～3cm and﹥3cm, then group 2～3cm accounted for 57.7% , and the 1-year survival rates of each group were 88.1%, 71.0% and 60.9%; the 3-year survival rates were 54.0%,29.3% and 27.1%; the 5-year survival rates were 54.0%, 19.2% and 22.4% respectively(P=0.002).The survival curves showed unreasonable result. When divided the patients into three groups by maximum LT dimension of GTV of≤3cm, 3～4cm and﹥4cm, the proportions of each group were 38.5%, 39.3% and 22.2% respectively, and the 1-year survival rates were 82.0%, 64.1%and 67.5%; the 3-year survival rates were 44.9%, 27.3% and 23.3%; the 5-year survival rates were 38.8%, 22.2% and 11.8% respectively(P=0.007). But the survival curves of group 3～4cm and group﹥4cm were crossed. When divided the patients into three groups by maximum extension of infiltration of GTV of≤1cm, 1～2cm and >2cm, then group 2～3cm accounted for 69.7%, and the 1-year survival rates of each group were 90.0%, 65.5% and 80.6%; the 3-year survival rates were 49.3%, 31.6% and 21.2%; the 5-year survival rates were 45.7%, 22.5% and 21.2% respectively(P=0.013). The survival curves showed unreasonable result.Section 3: According to the criteria for the staging of lymph node in Shijiazhuang Protocol, the 1-year survival rates of N-staging with lymph node negative or positive were 75.9% and 69.6%; the 3-year survival rates were 41.8% and 28.8%; the 5-year survival rates were 34.7% and 21.8% respectively(P=0.021). The survival curves were separated. When divided the patients into three groups by the total number of metastatic lymph nodes of 0, 1～2 and≥3, the 1-year survival rates were 75.9% 71.7% and 58.3%; the 3-year survival rates were 41.8%, 32.0% and 12.5%; the 5-year survival rates were 34.7%, 23.5% and 12.5% respectively(P=0.008). The survival curves were separated. When divided the patients three groups by the number of involved lymphatic drainage regions of 0, 1 and≥2, the 1-year survival rates were 75.9%, 72.2% and 58.6%; the 3-year survival rates were 41.8%, 30.7%, and 20.7%; the 5-year survival rates were 34.7%, 21.9% and 20.7% respectively(P=0.019). The survival curves were separated as well.Conclusions 1,The criteria of T stage is reasonable but N stage still need to be improved in Shijiazhuang Protocol. It will be more reasonable if define the para-esophagi-trachea lymph nodes in the supraclavicular area with maximum dimension≥5mm but <10mm as N1. 2,Total volume of GTV is an excellent prognostic indicator which is simpler and more objective. 3,The total number of metastatic lymph nodes and involved lymphatic drainage regions can make N stage more reasonable and provide more information to evaluate the prognosis. |
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