Evaluation The Relationship Between Gross Tumor Volume And Pathological T Staging And Its Prognosis Of Esophageal Carcinoma By Resected

Objective: To explore the coincidence of the gross tumor volume and pathological T staging of esophageal carcinoma with radical resection, and analysis the prognosis factors.Methods: Two hundred and sixty nine patients who underwent radical esophagectomy at the Fourth Hospital of Hebei Medical University with curative intent between May 2002 and June 2006 were retrospectively analyzed. All patients did not receive preoperative or postoperative chemoradiotherapy and had complete information of postoperative pathological materials. All of the patients had the CT scan at the hospital ahead the surgery one week. According to the esophageal conventional CT scaning, the slice thickness and the layer distance both were 3-6mm, the CT scanning followed layer by layer from the lower neck to superior abdomen level. The CT scanning image could be transmitted to the Philips TPS Pinnacle 7.6c American three-dimensional Treatment Planning System by the network at digital format and be reconstructed. The CT scans of 269 cases of esophageal carcinoma can be transmitted to the three-dimensional treatment planning system by the network at digital format.Esophageal GTV targets were outlined and the preoperative GTV volume were counted. The intraoperative GTV and the postoperative GTV were measured and counted by the formula (GTV=π/6*length*width*height), which is used to calculate the volume of ellipsoid tumor. To analysis whether there are differences of the GTV (preoperative, intraoperative and postoperative) among different pathological T stages. Take into account the median volume of GTV (preoperative, intraoperative and postoperative) in different pathological T stages and the separation of survival curve at the same time.Select a suitable classification standard of GTV (preoperative, intraoperative and postoperative). Then explore the coincidence of the GTV standard classification and pathological T staging, and its prognosis.Results: 12 cases were out of contact among these 269 cases, so the follow-up rate was 95.54%. The perioperative mortality were 5.20%(14/269), excluding the perioperative deaths, other patients'1-, 3-, 5-year survival rate were 81.14%, 51.11%, 37.40% respectively. The average survival time and median survival time were 46.15months and 36.83months respectively. The rate of locoregional recurrence was 44.31%,the distant metastasis rate was 12.16%。(1) In the whole group, the range of the preoperative GTV size was 0.70~94.81cm~3, and the median of the preoperative GTV size was 23.22cm~3. The range of the intraoperative GTV size was 0.08~263.76cm~3, the median of the intraoperative GTV size was 18.84cm~3. The range of the postoperative GTV size was 0.01 ~ 65.49cm~3, the median of the postoperative GTV size was 4.40cm~3. (2) With the pathological T stage increasing, there was an growth trend with the preoperative, intraoperative and postoperative GTV size of esophageal carcinoma, and there was an overlap range in distribution of tumor size in adjacent T staging. (3) Based on pathological T staging, divided the preoperative GTV volume into three grades:≤7cm~3, >7cm~3～≤14cm~3, >14cm~3, compared with T1,T2,T3+4 stage,the coincidence rate is 72.16%. The Consistency between the preoperative GTV volume level and pathologic staging was better, Kappa=0.402, P=0.000. The survival rates ofⅠ,Ⅱ,Ⅲgrades of preoperative GTV showed significant differences (χ~2=21.900, P=0.000). In the same way,divided the intraoperative GTV volume into three grades:≤2cm~3,>2cm~3～≤4cm~3,>4cm~3,compared with T1,T2,T3+4 stage,the coincidence rate is 74.12%. The consistency between the intraoperative GTV grades and pathologic staging is better (Kappa=0.338, P=0.000). The survival rates ofⅠ,Ⅱ,Ⅲgrades of intraoperative GTV showed significant differences (χ~2=13.564, P=0.000). Also,divided the postoperative GTV volume into three grades:≤0.5cm~3,>0.5cm~3～≤1.8cm~3,>1.8cm~3,compared with T1,T2,T3+4 stage,the coincidence rate is 73.73%. The consistency between the postoperative GTV volume level and pathologic staging is beteer (Kappa=0.356, P=0.000). The survival rates ofⅠ,Ⅱ,Ⅲgrades of postoperative GTV showed significant differences (χ~2=10.19, P=0.006). (4) By follow-up, the local-regional recurrence rate was 44.31%(113/255), their respective survival rates showed significant differences with those no-recurrence patients(χ~2=89.54, P=0.000). On the other hand the distant metastasis rate was 12.16%(31/255) in whole group. Their survival rates showed significant differences with those no-distant metastasis patients (χ~2=29.372, P=0.000).Conclusions: (1) With the T stage increasing, there was an incremental trend in the preoperative, intraoperative and postoperative GTV size of esophageal carcinoma, and there was an overlap in distribution of tumor size in adjacent T staging. (2) The three-grade of preoperative GTV can predict the prognosis of esophageal carcinoma (3) With the GTV volume increasing in esophageal cancer, the survival rate decreased gradually, the local recurrence rate and the distant metastasis rate increased gradually.