中文摘要：

目的探讨食管癌大体肿瘤靶区（GTV）体积与病理淋巴结转移及预后的关系。方法将607例根治性切除的胸段食管癌患者术前的CT图像传输至三维适形放疗计划系统中，根据CT表现并参考食管钡餐造影和食管镜检查结果确定病变部位和长度，勾画出食管肿瘤的GTV，并计算GTV体积。分析GTV体积与术后病理淋巴结转移数目及患者预后的关系。结果374例N0期患者的GTV体积为（22．5±16．8）cm3，233例N1期患者的GTV体积为（30．4±20．1）cm3，差异有统计学意义（P〈0．001）。尢淋巴结转移组与淋巴结转移的各组间GTV体积的差异均有统计学意义（均P〈0．05），食管癌GTV体积的大小与术后淋巴结转移数目间存在正相关关系（r=0．230，P〈0．001）。全组607例食管癌患者根治术后的1、3、5年生存率分别为83．8％、53．5％和36．4％。N1期患者的5年生存率为18．2％，明显低于N0期患者（48．5％，P〈0．001）。Cox多因素分析的结果显示，食管癌GTV体积、淋巴结转移数目、病理类型和病变部位是影响患者预后的独立因素（均P〈0．05）。结论食管癌的GTV体积与术后病理淋巴结转移数目呈正相关关系，食管癌的GTV体积是影响食管癌患者预后的独立因素。

英文摘要：

Objective To explore whether there is a relationship between gross tumor volume （GTV） and pathologic lymph node metastasis or prognosis of esophageal carcinoma, and to provide a new prognosis reference for esophageal carcinoma （ EC ）. Methods Six hundred and seven patients received radical resection of thoracic esophageal carcinoma from May 2002 to June 2006 in our hospital, and their pre-operative CT images were transmitted to the three-dimensional conforrnal radiotherapy planning system by the network in digital format. Esophageal GTV targets were outlined and their GTV volumes were calculated. To analyze whether there is a relationship between GTV volume and pathologic lymph node metastasis or prognosis. Results In the 607 cases of esophageal carcinoma, the GTV volume was （22.5±16.8） cm3 in 374 stage NO EC patients, significantly different from that of （30.4 ±20.1 ）cm3 in 233 stage N1 EC cases （ P 〈 0. 001 ）. There is a significant difference between the GTV volumes of the groups with and without lymph node metastasis （P 〈 0.05 ）. There was a significant difference of the GTV volumes of EC patients with one lymph node metastasis and those with ≥4 lymph node metastasis （P 〈 0.05 ）. There was a positive correlation between GTV volume and the number of lymph node metastasis （ r = 0. 230, P 〈 0. 001 ）. The 1-, 3-, 5-year survival rates since the surgery date were 83.8% ,53.5% , and 36.4%, respectively. There was a significant difference between the survival rates of stage NO （48.5%） and stage N1 patients （ 18.2% , P 〈0.001 ）, and there was a significant difference between the survival rats of patients with 0, 1 and ≥2 lymph node metastasis （ P 〈 0.01 ）. Cox regression model analysis showed that GTV volume, number of lymph node metastasis, pathological type, and lesion site were independent prognostic factors （all P 〈 0.05 ）. Condusion The GTV volume of esophageal carcinoma is positively correlated with the number of pathologic lymph node metastasi