Efficacy of Endoscopic Ultrasonography for Determining Clinical T Category for Esophageal Squamous Cell Carcinoma: Data From 1434 Surgical Cases
Efficacy of Endoscopic Ultrasonography for Determining Clinical T Category for Esophageal Squamous Cell Carcinoma: Data From 1434 Surgical Cases
复制标题
超声内镜确定食管鳞状细胞癌临床 T 类别的疗效：来自 1434 例手术病例的数据
DOI：
10.1245/s10434-018-6406-9
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发表时间：
2018-07-01
影响因子：
3.7
通讯作者：
Yang, Hao-Xian
中科院分区：
文献类型：
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作者：
Yang, Jie;Luo, Guang-Yu;Yang, Hao-Xian
背景超声内镜（EUS）确定食管鳞状细胞癌（ESCC）T 类别的效果各不相同。我们的目的是根据第八版 AJCC 癌症分期手册评估 EUS 在准确识别 ESCC T 类别方面的功效。方法使用前瞻性收集的 2003 年 1 月至 2015 年 12 月的 ESCC 数据库进行回顾性分析，其中所有患者均接受 EUS 检查，然后进行食管切除术。 EUS的疗效通过与病理T分类作为金标准比较的敏感性、特异性和准确性来评估。评估不同EUS-T（uT）类别的总生存率。结果总共纳入1434例患者，其中58.2%的患者经EUS正确分类，其中17.9%被高分期，23.9%被低分期。 EUS 对 Tis、T1a、T1b、T2、T3 和 T4a 类别的敏感性和准确性分别为 15.8 和 98.8%、16.3 和 95.7%、33.1 和 89.3%、56.8 和 65.0%、65.8 和 70.0%、27.3 和 97.5%。 uT1a和uT1b之间的生存率差异不具有统计学意义（p= 0.90），uT4a和uT4b之间的生存率差异也不具有统计学意义（p= 0.34）。然而，当uT类别整合为uTis、uT1、uT2、uT3和uT4时，各类别之间的总生存率明显不同(p< 0.01)。结论EUS对于ESCC临床T类别的分类总体上是可行的。然而，应谨慎使用 EUS 来区分 Tis、T1a 和 T1b 疾病以及 T4 疾病。
BackgroundThe efficacy of endoscopic ultrasonography (EUS) for determining T category is variable for esophageal squamous cell carcinoma (ESCC). We aimed to assess the efficacy of EUS in accurately identifying T category for ESCC based on the 8th AJCCCancer Staging Manual.MethodsA retrospective analysis was conducted using a prospectively collected ESCC database from January 2003 to December 2015, in which all patients underwent EUS examination followed by esophagectomy. The efficacy of EUS was evaluated by sensitivity, specificity, and accuracy compared with pathological T category as gold standard. Overall survival of different EUS-T (uT) categories was assessed.ResultsIn total, 1434 patients were included, of whom 58.2% were correctly classified by EUS, with 17.9% being overstaged and 23.9% being understaged. The sensitivity and accuracy of EUS for Tis, T1a, T1b, T2, T3, and T4a categories were 15.8 and 98.8%, 16.3 and 95.7%, 33.1 and 89.3%, 56.8 and 65.0%, 65.8 and 70.0%, and 27.3 and 97.5%, respectively. The survival difference between uT1a and uT1b was not statistically significant (p= 0.90), nor was that between uT4a and uT4b (p= 0.34). However, when uT category was integrated as uTis, uT1, uT2, uT3, and uT4, overall survival was clearly distinguished between the categories (p< 0.01).ConclusionsEUS is in general feasible for classifying clinical T category for ESCC. However, EUS should be used with caution for discriminating between Tis, T1a, and T1b disease, as well as T4 disease.