Preoperative prediction of a pathologic complete response of esophageal squamous cell carcinoma to neoadjuvant chemoradiotherapy
Preoperative prediction of a pathologic complete response of esophageal squamous cell carcinoma to neoadjuvant chemoradiotherapy
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DOI：
10.1016/j.surg.2018.01.011
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发表时间：
2018-07-01
期刊：
影响因子：
3.8
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
--
作者：
Hamai, Yoichi;Hihara, Jun;Okada, Morihito
背景资料：病理完全缓解的准确预测食管癌新辅助放化疗后，术前对食管癌组织病理学分级（ypTONOM [LYM] 0 ypStage 0）的评估对选择合适的治疗策略至关重要。我们回顾了130例食管鳞状细胞癌患者，这些患者在术前进行了上消化道内窥镜检查、计算机断层扫描，和F-18-氟脱氧葡萄糖-正电子发射断层扫描后，新辅助放化疗，随后进行食管切除术。我们的目的是确定计算机断层扫描，F-18-氟脱氧葡萄糖-正电子发射断层扫描和内窥镜的诊断能力，术前预测局部晚期食管鳞状细胞癌原发部位和相关淋巴结对三模式新辅助放化疗的病理完全反应。结果：29例（22.3%）和43例（33.1%）患者分别获得了临床完全缓解和病理完全缓解，两者相关（P= 0.001）。临床完全缓解对病理完全缓解的敏感性、特异性、阳性预测值和阴性预测值分别为39.5%、86.2%、58.6%和74.3%。单变量和多变量分析选择临床完全缓解作为病理完全缓解的唯一独立术前预测因素（临床完全缓解与非临床完全缓解：比值比：0.26，95%置信区间，0.10-0.65，P= 0.004）。有临床完全缓解的患者的无复发率和总生存率（OS）高于无临床完全缓解的患者（5年无复发率和总生存率：分别为69.0%和41.4%，75.9%和45.0%，均P= 0.02）。此外，临床完全缓解是无复发生存期的独立术前预测因子（临床完全缓解与非临床完全缓解：风险比：2.20，95%置信区间，1.08-4.45，P=.03）。结论：尽管病理完全缓解在某种程度上是术前可预测的，但准确性有点低。在根据需要选择观察和等待手术方法并省略计划的手术干预时，即使对于新辅助放化疗后达到临床完全缓解的患者，也应谨慎行事。(C)2018爱思唯尔公司All rights reserved.
Background: The accurate prediction of a pathologic complete response (ypTONOM [LYM] 0 ypStage 0) before operation is essential for selecting appropriate strategies for treating esophageal cancer after neoadjuvant chemoradiotherapy.Methods: We reviewed 130 consecutive patients with esophageal squamous cell carcinoma who were evaluated preoperatively using upper gastrointestinal endoscopy, computed tomography, and F-18-fluorodeoxyglucose-positron emission tomography after neoadjuvant chemoradiotherapy and subsequently underwent esophagectomy. Our aim was to determine the diagnostic abilities of computed tomography, F-18-fluorodeoxyglucose-positron emission tomography, and endoscopy to predict preoperatively a pathologic complete response of the primary site of the locally advanced esophageal squamous cell carcinoma and associated lymph nodes to trimodal neoadjuvant chemoradiotherapy. Associations between clinical complete response (ycTONOM [LYM] 0 ycStage 0) and pathologic complete response were investigated preoperatively.Results: Twenty-nine (22.3%) and 43 (33.1%) patients, respectively, achieved clinical complete response and pathologic complete response, which were associated (P=.001). The sensitivity and specificity, as well as the positive and negative predictive values of clinical complete response to define pathologic complete response were 39.5%, 86.2%, 58.6%, and 74.3%, respectively. Univariate and multivariate analyses selected clinical complete response as the sole independent preoperative predictor of pathologic complete response (clinical complete responses versus non-clinical complete responses: odds ratio: 0.26, 95% confidence interval, 0.10-0.65, P=.004). Recurrence-free and overall survival (OS) rates were better in patients with than in those without clinical complete response (5-year recurrence-free and overall survival: 69.0% vs 41.4% and 75.9% vs 45.0%, respectively, both P=.02). Furthermore, clinical complete response was an independent preoperative predictor of recurrence-free survival (clinical complete response versus nonclinical complete response: hazard ratio: 2.20, 95% confidence interval, 1.08-4.45, P=.03).Conclusion: Although pathologic complete response was predictable preoperatively to some extent, the accuracy was somewhat low. Considerable caution should be exercised when selecting the watch-and wait approach with operation as needed and omitting planned operative intervention even for patients who achieve clinical complete response after neoadjuvant chemoradiotherapy. (C) 2018 Elsevier Inc. All rights reserved.