Preoperative staging of gastric cancer by endoscopic ultrasound - The prognostic usefulness of ascites detected by endoscopic ultrasound
Preoperative staging of gastric cancer by endoscopic ultrasound - The prognostic usefulness of ascites detected by endoscopic ultrasound
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DOI：
10.1097/00004836-200210000-00008
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发表时间：
2002-10-01
影响因子：
2.9
通讯作者：
Yeh, YH
中科院分区：
文献类型：
--
作者：
Chen, CH;Yang, CC;Yeh, YH
背景资料：内镜超声（EUS）是胃癌局部术前分期的标准方法，据说能够检测腹水。然而，EUS检测到的腹水与局部肿瘤分期、腹膜癌转移或手术后生存率之间的相关性还没有很好的记录。目的：评估EUS在胃癌术前分期和腹水检测中的准确性、敏感性和特异性。我们也尝试将腹水与胃癌的组织学分期、肿瘤分化程度及术后存活率相关联。研究项目：回顾性分析了57例组织学证实的胃腺癌患者，这些患者在手术前接受了EUS。将EUS的准确性与最终的病理结果进行比较。我们通过分析胃腺癌的临床病理特征和随访其生存率来评估其预后价值。结果：EUS对肿瘤T分期的准确率为88%。T分期的准确性如下：T1，100%; T2，33%; T3，93%;和T4，100%。大约50%的T2病例被过度分期。EUS检测淋巴结转移的准确性、敏感性和特异性分别为79%、79%和80%。7例T1癌中有1例有区域淋巴结转移，EUS漏诊，尽管T分类是基于发现粘膜下浸润而精确分期的。共22例（39%）患者经EUS检测到腹水，EUS显示腹水的敏感性和特异性均为100%。腹水与肿瘤浸润深度（p = 0.036）、淋巴结转移（p = 0.008）和细胞分化差（p = 0.007）显著相关，但与肉眼可见的腹膜癌转移无关。胃癌伴淋巴结转移、腹水、低分化者手术后生存率低（P < 0.05）。然而，多变量分析显示淋巴结转移是唯一显著的预后预测因子（p = 0.004）。结论：超声内镜在胃癌局部分期和腹水显示方面是一种有价值的诊断工具。虽然有淋巴结转移、腹水或分化差的胃癌患者手术治疗的生存率较低，但多因素分析显示只有淋巴结转移是一个显著的预后预测因素。
Background: Endoscopic ultrasound (EUS) is the standard modality in local preoperative staging of gastric cancers and is reputedly able to detect ascites. However, the association between ascites detected by EUS and local tumor staging, peritoneal carcinomatosis, or survival after surgery is not well documented. Goals: To assess the accuracy, sensitivity, and specificity of EUS in the preoperative staging and detection of ascites in gastric cancers. We also try to correlate ascites with histologic staging, tumor differentiation, and survival rate of gastric carcinoma after surgery. Study: The retrospective analysis was made in 57 consecutive patients with histologically confirmed gastric adenocarcinomas that underwent EUS before surgery. The accuracy of EUS was compared with the final surgical-pathologic findings. We estimated the prognostic usefulness by analyzing the clinicopathologic features of gastric adenocarcinomas and following up their survival rates. Results: The overall T staging was 88% accurate by EUS. The accuracy for T staging was as follows: T1, 100%; T2, 33%; T3, 93%; and T4, 100%. About 50% of T2 cases were overstaged. The overall accuracy, sensitivity, and specificity of detecting lymph node metastasis by EUS were 79%, 79%, and 80%, respectively. One of the seven T1 cancers had regional lymph node metastasis, and it was missed by EUS, although the T classification was precisely staged based on finding submucosal invasion. A total of 22 patients (39%) had ascites detected by EUS; both the sensitivity and specificity of EUS in demonstrating ascites were 100% in our study. Ascites was significantly correlated with the depth of tumor invasion (p = 0.036), lymph node metastasis (p = 0.008), and poor cellular differentiation (p = 0.007), but it was not significantly correlated with macroscopic peritoneal carcinomatosis. The survival rate after surgical treatment was poor in those with gastric cancers with lymph node metastasis, ascites, or poorly differentiated tumors (p < 0.05). However, multivariate analysis showed that lymph node metastasis was the only significant prognostic predictor (p = 0.004). Conclusions: Endoscopic ultrasound is a valuable diagnostic tool in the local staging of gastric cancers and demonstration of ascites. Although the surgical treatment of gastric cancers with lymph node metastasis, ascites, or poor differentiation had poorer survival rate, only lymph node metastasis was proved to be a significant prognostic predictor in multivariate analysis.