Clinical study of non-operative staging of esophageal squamous cell carcinoma underwent intensity-modulated radiotherapy combined with chemotherapy

Abstract

Objective To compare different non-operative clinical staging criteria regarding their accuracy and feasibility in evaluation of patients with esophageal squamous cell carcinoma (ESCC) receiving concurrent intensity-modulated radiotherapy (IMRT) and chemotherapy. Methods A study was performed on clinical data from 242 ESCC patients who received concurrent IMRT and chemotherapy in our hospital from 2008 to 2014. Prognostic prediction was compared between the Chinese 2009 staging system, the 6th edition staging system, and a suggested staging system. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. A prognostic analysis was made by the Cox model. Results The 3-year sample size and overall survival rate were 168 and 47.4%, respectively. Esophageal tumor volume and the maximum diameter of metastatic lymph nodes were prognostic factors (P=0.000, 0.000). An intersection of T3 and T4 survival curves was found in the Chinese staging system and the 6th version staging system (P=0.696, 0.594), while an intersection of N1 and N2 survival curves was found in the Chinese staging system (P=0.068). The T staging based on esophageal tumor volume, N staging based on the maximum diameter of metastatic lymph nodes, and their combination could achieve a good separation of survival curves of different stages (P=0.000, 0.000, 0.000). Conclusions The T staging based on esophageal tumor volume combined with the N staging based on the maximum diameter of metastatic lymph nodes is an convenient non-operative clinical staging approach for prognostic prediction of ESCC patients receiving concurrent IMRT and chemotherapy. Key words: Esophageal neoplasms/intensity-modulated radiotherapy; Esophageal neoplasms/chemotherapy; Neoplasm staging; Prognosis