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首页> 外文期刊>Surgical Endoscopy >The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer
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The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer

机译：内镜超声在评估食管癌新辅助化疗后肿瘤反应和分期中的作用

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Background: Although the role of endoscopic ultrasound (EUS) in the initial staging of esophageal cancer is well established, its role in assessing tumor response and staging esophageal cancers after neoadjuvant chemotherapy (NAC) is controversial, and this study aimed to investigate this role. Methods: This study retrospectively analyzed 110 patients with esophageal cancer who underwent EUS by single surgeon before and after NAC. Tumor response was assessed before and after NAC. Patients with more than a 50% reduction in tumor size based on EUS evaluation were classified as having a significant response to chemotherapy, and those with less than a 50% reduction were categorized as having a partial response. Disease stage was established by tumor node metastasis (TNM) classification. Initial staging was performed using EUS and computed tomography (CT) scans of the chest and abdomen. The EUS-determined stage was compared with the postsurgical pathologic stage. χ 2 analysis and Fisher's exact testing were performed. Results: A response to NAC was shown by 96 patients (87.3%) and no response by 14 patients (12.7%). Of the 96 responding patients, 37 (38.5%) showed a significant response, whereas 43 (61.5%) of 69 patients showed a partial response. The EUS staging correlated well with the pathologic staging for 9 (64.3%) of the 14 nonresponders and for 34 (35.4%) of the 96 responders to NAC (P = 0.04). The EUS accurately predicted both the T and N status for 26 (23.6%) of the 110 patients. Prediction of N status was significantly more accurate than prediction of the T stage for the post-NAC patients. Of the 110 patients, 43 (39.1%) patients had an accurate T-stage prediction, and 64 (58.2%) had an accurate N stage match (P = 0.02). The T stage was overstaged for 60 (54.5%) of the patients and understaged for 7 of the patients (6.4%).The study found overstaging of the T stage to be more common among the patients who responded to chemotherapy. The N stage was overstaged for 25 (22.7%) and understaged for 21 (19.1%) of the 110 patients. Conclusion: The findings showed EUS to be a useful tool for assessing response to chemotherapy and for evaluating the extent of disease, thus facilitating surgical decision making. However, EUS is an unreliable tool for staging esophageal cancer after NAC. Overstaging of the T stage is significantly more common and could be related to the inflammatory effect or fibrosis after NAC.
机译：背景：尽管内镜超声（EUS）在食管癌的初始分期中的作用已得到充分确立，但其在新辅助化疗（NAC）后评估肿瘤反应和分期食管癌中的作用尚存在争议，本研究旨在探讨这一作用。方法：本研究回顾性分析了110名食管癌患者，在NAC之前和之后均由一名外科医生进行了EUS。在NAC之前和之后评估肿瘤反应。根据EUS评估，肿瘤大小缩小50％以上的患者被分类为对化疗有显着反应，而肿瘤缩小小于50％的患者则被分类为部分响应。通过肿瘤结转移（TNM）分类确定疾病阶段。初始分期使用EUS和胸部和腹部的CT扫描进行。将EUS确定的阶段与术后病理阶段进行比较。进行了χ2分析和Fisher的精确检验。结果：96例患者（87.3％）对NAC有反应，而14例患者（12.7％）无反应。在96例反应患者中，有37例（38.5％）表现出显着反应，而69例患者中有43例（61.5％）表现出部分反应。 EUS分期与14例无反应者中的9例（64.3％）和96例NAC者中的34例（35.4％）的病理分期相关性良好（P = 0.04）。 EUS可以准确预测110例患者中的26例（23.6％）的T和N状态。对于NAC后患者，N状态的预测比T期的预测准确得多。在110位患者中，有43位（39.1％）患者具有准确的T期预测，有64位（58.2％）具有准确的N期匹配（P = 0.02）。 T期对60例患者（54.5％）进行了过度分期，而7例（6.4％）患者的阶段性进行了低估。研究发现，对化疗有反应的患者中T期的过度分期更为常见。在110例患者中，N阶段被过度分级为25（22.7％），而21阶段（19.1％）被分级为低。结论：研究结果表明，超声内镜是评估化疗反应和评估疾病程度的有用工具，从而有助于手术决策。但是，EUS是NAC后分期食管癌的不可靠工具。 T期的过度分期更为普遍，可能与NAC后的炎症作用或纤维化有关。

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