Endoscopic Ultrasound in Staging Esophageal Cancer After Neoadjuvant Chemotherapy-Results of a Multicenter Cohort Analysis
Endoscopic Ultrasound in Staging Esophageal Cancer After Neoadjuvant Chemotherapy-Results of a Multicenter Cohort Analysis
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DOI：
10.1007/s11605-013-2189-2
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发表时间：
2013-06-01
影响因子：
3.2
通讯作者：
Meister, Tobias
中科院分区：
文献类型：
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作者：
Heinzow, Hauke Sebastian;Seifert, Hans;Meister, Tobias
内镜超声（EUS）被认为是食管癌初始分期的金标准。EUS是否对新辅助化疗（NAC）后的肿瘤分期有用一直存在争议。回顾性分析了95例食管癌患者。在45例患者中，EUS在NAC之前和之后进行，而50例患者没有进行诱导治疗。通过手术获得组织学相关性。将uT/uN分类与pT/pN分期进行比较。统计学分析包括敏感性、特异性和准确率的计算。超声内镜检查与Cohen kappa分期的一致性进行了评估，对于那些既往接受过NAC的患者，yuT和yuN分类的总体准确性分别为29%和62%。NAC后局部肿瘤扩展的灵敏度、特异性和准确率如下（%）：T1：-/97/84，T2：13/76/53，T3：86/29/46，T4：20/100/91，T1/2：27/83/56，T3/4：89/31/56。Cohen的kappa值表明yuT分类和ypT分期之间的一致性较差（kappa = 0.129）。相对于阳性淋巴结检测，敏感性和特异性分别为100%和6%（kappa = 0.06）。23例（51%）患者的T分期过高，7例（16%）患者的T分期过低。NAC后T分期的过度分期很常见。
Endoscopic ultrasound (EUS) is considered a gold standard in the initial staging of esophageal cancer. There is an ongoing debate whether EUS is useful for tumor staging after neoadjuvant chemotherapy (NAC).Ninety-five patients with esophageal cancer were retrospectively analyzed. In 45 patients, EUS was performed prior to and after NAC, while 50 patients had no induction therapy. Histological correlation through surgery was available. uT/uN classifications were compared to pT/pN stages. Statistical analysis included calculation of sensitivity, specificity, and accuracy rates. Agreement between endosonography and T staging was assessed with Cohen's kappa statistics.For those patients with prior NAC, overall accuracy of yuT and yuN classification was 29 and 62%, respectively. Sensitivity, specificity, and accuracy rates for local tumor extension after NAC were as follows (%): T1: -/97/84, T2: 13/76/53, T3:86/29/46, T4:20/100/91, T1/2: 27/83/56, T3/4: 89/31/56. Cohen's kappa indicated poor agreement (kappa = 0.129) between yuT classification and ypT stage. Relative to positive lymph node detection, sensitivity and specificity were 100 and 6%, respectively (kappa = 0.06). T stage was overstaged in 23 (51%) and understaged in seven (16%) patients.EUS is an unreliable tool for staging esophageal cancer after NAC. Overstaging of the T stage is common after NAC.