Clinical Significance of Endoscopic Response Evaluation to Predict the Distribution of Residual Tumor after Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma
Clinical Significance of Endoscopic Response Evaluation to Predict the Distribution of Residual Tumor after Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma
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DOI：
10.1245/s10434-021-11009-7
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发表时间：
2021-11-23
影响因子：
3.7
通讯作者：
Kitagawa, Yuko
中科院分区：
文献类型：
--
作者：
Matsuda, Satoru;Kawakubo, Hirofumi;Kitagawa, Yuko
目的术前了解残留病灶的分布情况，包括病理淋巴结（LN）和复发部位，以便对新辅助化疗（NAC）有效的患者采取包括后续放化疗（CRT）在内的器官保护措施。本研究旨在评价内镜反应评价是否可以预测残留肿瘤分布。方法回顾性分析经胸食管切除术（TTE）治疗的食管鳞癌患者的临床资料。根据原发肿瘤内镜检查结果定义NAC内镜应答者（ER）。比较两组间的无复发生存期（RFS）、总生存期（OS）和残留肿瘤模式。结果193例患者中，40例（20%）被归类为ER。ER显示出显著更好的RFS和OS。在88%的ER中，在原发肿瘤和cN野内发现pN位置，这显著高于非ER的63%（p = 0.004）。此外，ER组远端器官的术后复发率显著低于非ER组（分别为8%、32%，p = 0.002）。88%的ER患者的残留病灶（包括术后首次复发）与原发肿瘤和cN存在于同一视野内，显著高于非ER患者的42%（p < 0.001）。结论内镜反应评估可预测NAC后残留肿瘤的分布，对选择TTE的患者在确定性CRT中的射野选择有一定的指导意义。沿着NAC应答率的提高，这可能有助于对NAC有应答的患者的器官保存。
Purpose To appropriately adopt the organ preservation approach, including subsequent chemoradiotherapy (CRT) in patients who respond to neoadjuvant chemotherapy (NAC), the distribution of residual disease, including pathological lymph nodes (LNs) and recurrence site, needs to be recognized preoperatively. This study was designed to evaluate whether endoscopic response evaluation can predict residual tumor distribution. Methods Patients with esophageal squamous cell carcinoma who underwent transthoracic esophagectomy (TTE) were retrospectively reviewed. Endoscopic responder (ER) to NAC was defined according to primary tumor endoscopic findings. Recurrence-free survival (RFS), overall survival (OS), and residual tumor patterns were compared between groups. Results Of 193 patients, 40 (20%) were classified as ER. ERs showed significantly better RFS and OS. The pN location was found within the primary tumor and cN field in 88% of ERs, which was significantly higher than non-ERs at 63% (p = 0.004). Furthermore, the postoperative recurrence incidence in the distant organ was significantly lower in the ERs than the non-ERs (8%, 32%, respectively, p = 0.002). Residual disease, including postoperative initial recurrence, existed within the same field as the primary tumor and cN in 88% of ERs, significantly higher than 42% in the non-ERs (p < 0.001). Conclusions Endoscopic response evaluation can preoperatively predict distribution of residual tumors after NAC, which could help radiation field selection in subsequent definitive CRT when patients prefer to omit TTE. Along with improvements in NAC response rate, this could facilitate organ preservation in patients who respond to NAC.