转移性食管鳞癌的治疗

• Nx:
Regional lymph node can not be assessed
• N0:
No regional lymph node metastases
• N2:
3 to 6 positive regional lymph nodes
• N3:
7 or more positive regional lymph nodes
• T2 muscularis propria
• T3 adventitia
• T4 adjacent structures T4a pleura, pericardium, diaphragm, or adjacent
peritoneum
• T4b other adjacent structures,
• EUS • EUS-FNA
Clinical T stage
CT
• 基础检查方法 • CT正常食管壁≤3mm • 准确性低于EUS • T3、T4准确性高 • T4：与组织间的脂肪垫 • 与主动脉接触角度大于90度 • 食管、主A、椎体之间的三角脂肪垫消失 • 气管支气管侵犯
EUS
• 术前分期最准确 • 准确性90% • 敏感性81-90% • 特异性99%
e.g. aorta, vertebral body,trachea
N stage
• Any periesophageal lymph node from cervical lymph nodes to celiac node
• N1:
1 to 2 positive regional lymph nodes
• Adenocarcinoma • Squamous cell carcinoma • Undifferentiated
Histologic grade
• G1: Well differentiated • G2: Moderately differentiated • G3: Poorly differentiated • G4: Undifferentiated
• 缺点：缩窄型肿瘤
Clinical N stage
• CT
• 根据淋巴结短径 • 胸腹腔10mm，锁骨上5mm，腹膜后6mm
• EUS：
• 准确性74%-90% • EUS/FNA: 87%-100%
• Meta：敏感性59%，特异性81%
• PET,PET/CT
• 敏感性(33-37%)低于EUS • 特异性高(90%)
stage
0 IA IB IIA IIB IIIA
IIIB IIIC
IV
Stage Groupings of Squamous Cell Carcinoma
T
Tis (HGD)
1
1 2-3
2-3 2-3
2-3 1-2
1-2 3 4a
3
4a 4b any
any
N
M
G
0
0
1
0
0
1
0
ቤተ መጻሕፍቲ ባይዱ
0
2-3
0
0
1
0
0
1
转移性食管鳞癌的治疗
GLOBOCAN 2012
GLOBOCAN 2012：China
Survival data ：China 2010
Annals of Translational Medicine, Vol 2, No 7 July 2014
Work-up
• 体检，血常规/生化 • CT:胸腹部 • PET/CT • GI造影 • 腔镜+活检
8th？
• Stage 0 and Stage IV？ • Adding staging classifications • Assessing other non-anatomic tumor characteristics that affect survival • Adding non-esophagectomy survival data endoscopic treatment in Stage 0, IA ，
0
0
2-3
0
0
2-3
1
0
any
2
0
Any
1
0
Any
0
0
any
2
0
any
1-2
0
Any
Any
0
Any
N3
0
any
any
1
any
location
any
any
Any lower
Upper, middle lower
Upper, middle any
Any Any any
any
Any Any any
any
Overall survival
Survival of squamous cell carcinoma
30 days 98% 1 year 78% 5 year 42% 10 year 31%
T.W. Rice, Worldwide esophageal cancer collaboration, Diseases of the Esophagus 2009;22:1-8
M stage
• Mx Distant metastasis cannot be assassed
• M0 No distant metastasis
• M1 Distant metastasis
nonanatomical cancer characteristics
Histopathologic cell type
7th TNM stage
T stage
• Tx:
primary tumor can not be assessed
• Tis
Carcinoma in situ /High-grade dysplasia
• T1: lamina propria or submucosa
T1a lamina propria or muscularis mucosae T1b submucosa
Progression from 6th
• T stage
• Tis的定义：HPG • T4进一步分为：T4a和T4b
• N stage
• 根据转移数目 • 区域淋巴结
• M stage
• 取消M1a和M1b
• 组织分化纳入分期
• 病理类型 • 解剖部位
limitations
• 数据库时间跨度太大，包括R1及R2切除病例 • G4或未分化仅7例！ • Tis内镜下切除和外科切除差别？ • T1a和T1b • only surgery or pathologic stage？缺乏临床分期！ • Inoperative and advanced disease? • 分期对治疗的指导意义？ • 颈段食管癌？