Clinical Research Papers:
Survival based radiographic-grouping for esophageal squamous cell carcinoma may impact clinical T stage
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Abstract
Wenjie Cai1,*, Jiade J. Lu2,*, Rongyu Xu3, Peiling Xin1, Jun Xin4, Yayun Chen1, Bingzhong Gao1, Jieyun Chen5 and Xiyang Yang6
1Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
2Shanghai Proton and Heavy Ion Center, Shanghai 201315, P. R. China
3Department of Surgical Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
4Department of Surgery, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
5Department of Radiology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
6Key Laboratory of Intelligent Computing and Information Processing, Quanzhou Normal University, Quanzhou 362000, P. R. China
*These authors have contributed equally to this work
Correspondence to:
Xiyang Yang, email: [email protected]
Keywords: esophageal cancer; tumor staging; CT; imaging; prognosis
Received: August 13, 2017 Accepted: January 02, 2018 Published: January 09, 2018
ABSTRACT
Most patients diagnosed with thoracic esophageal squamous cell carcinoma (ESCC) have progressed beyond surgical resection as a therapeutic option. Difficulties in the proper assessment of tumor invasion depth before treatment complicate determination of the type and extent of therapy. Therefore, accurate tumor clinical staging is a necessity for identifying treatment options and aiding in patient prognosis. We investigated radiographic factors as prognostic indicators for survival in ESCC. Between July 2006 - July 2010, 324 thoracic ESCC patients who underwent surgery were selected. All patients received contrast enhanced preoperative chest CT scans and esophageal barium swallow examinations. Measurement of maximal lesion cross-sectional area, the largest long diameter, largest short diameter, CT-indicated lesion length, barium-indicated lesion length and the length of pericardial fat reduction were performed. Relationships between these indicators and post-surgical survival time and the cutoff values of related factors were analyzed. Maximum long diameter, maximum lesion area and lesion length, as measured by CT imaging, were correlated with survival. Survival effects were clearly associated with group intervals, calculated by a genetic algorithm, and tumor stages. Risk-stratification intervals of esophageal lesions from radiographic imaging included: maximum long diameter < 28.7, 28.7-34.6mm, 34.6-41.4mm and >41.4mm; maximum lesion area < 355.8mm2, 355.8-568.0mm2, 568.0-907.3mm2 and >907.3mm2; and CT-indicated lesion length <30.9mm, 30.9-57.3mm, 57.3-70.6mm and > 70.6mm. The reasonable stratification of maximum esophageal lesion area, largest long diameter and lesion length measured in CT is valuable for clinical T staging of ESCC. Radiographic parameters may have prognostic clinical value in the staging of esophageal carcinoma.
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