Establishment of the individual treatment strategy in multidiciplinary therapy for patients with advanced esophageal squamous cell carcinoma

晚期食管鳞癌多学科治疗个体化治疗策略的建立

• 批准号: 14571195
• 负责人: YASUDA Takushi
• 金额: $ 2.62万
• 依托单位: Osaka University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2002
• 资助国家: 日本
• 起止时间: 2002 至 2003
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-14571195/
• 关键词: multidisciplinary therapy; FDG-PET; SUVmax; p53; salvege surgery; histological response; tumor blood flow; perfusion CT; 集学的治療効果予測; SUV; 組織学的効果予測; pathological CR

(1) Prediction of the response to preoperative therapy by p53 status for patients with advanced esophageal squamous cell carcinoma (SCC).The presence or absence of mutation within exon 4 to 9 of p53 gene was analyzed with endoscopic biopsy sample before treatment using SSCP technique. Chemoradiotherapy was received in 67 patients, who were divided in 48 of wild type (WT) and 19 of mutant (MT). Grade 2 or more histological response was obtained in 31 of WT group (65%), to the contrary, in only 2 of MT group (11%). In 30 patients who underwent chemotherapy, WT and MT were observed in 21 and 9 patients, respectively. Clinically good responders were shown in 16 of WT group (76%) and only I of MT group (11%).(2) Response evaluation of neoadjuvant therapy by FDG-PET prediction of histological response.According to post treatment PET analysis, patients with or without FDG accumulation were classified in PET positive or PET negative. The maximum cross-sectional square area of residual tumor ranged from 0 to 32.6mm2 (average 10.0mm2) in PET negative group and from 66.0 to 676.0mm2 (average 287.7mm2) in PET positive group. The histological good response of grade 2 to 3 was obtained in 15 of PET negative patients (88%) and in only 2 of PET positive patients (12%).(3) Positive indication of salvage surgery.The 1-and 3-year overall survival rate were 93.3% and 81.7% in PET negative group compared with 67.8% and 40.7% in PET positive group.Conclusion: In multidisciplinary treatment for advanced esophageal SCC, the analysis of p53 status is useful to predict a treatment resistance and also FDG-PET may be the extremely useful modality to predict a histological response after neoadjuvant therapy. Post-treatment PET negative patient may be a good candidate for salvage surgery.

(1)通过p53状态预测晚期食管鳞状细胞癌(SCC)患者对术前治疗的反应。采用SSCP技术在治疗前通过内镜活检样本分析p53基因4至9外显子内是否存在突变。 67例患者接受化放疗，其中野生型（WT）48例，突变型（MT）19例。 WT组有31例（65%）获得2级或以上的组织学缓解，而MT组仅有2例（11%）。在 30 名接受化疗的患者中，分别有 21 名和 9 名患者观察到 WT 和 MT。 WT组有16例（76%）表现出临床良好反应，MT组仅有1例（11%）。（2）通过FDG-PET预测组织学反应评估新辅助治疗的疗效。根据治疗后PET分析，将有或无FDG蓄积的患者分为PET阳性或PET阴性。 PET阴性组残留肿瘤最大横截面积为0～32.6mm2（平均10.0mm2），PET阳性组残留肿瘤最大横截面积为66.0～676.0mm2（平均287.7mm2）。 PET阴性患者15例（88%）获得2~3级组织学良好缓解，PET阳性患者仅有2例（12%）。（3）挽救手术阳性指征。PET阴性组1年和3年总生存率分别为93.3%和81.7%，而PET阳性组分别为67.8%和40.7%。结论：在晚期晚期患者的多学科治疗中食管鳞状细胞癌，p53状态分析 FDG-PET 可用于预测治疗耐药性，而且 FDG-PET 可能是预测新辅助治疗后组织学反应的极其有用的方法。治疗后 PET 阴性患者可能是挽救手术的良好人选。

项目成果

安田卓司, 矢野雅彦, 他: "外科切除成績からみた食道がん治療における化学放射線療法の適応と意義"癌の臨床. 50(2). 111-118 (2004)

Takuji Yasuda、Masahiko Yano 等人：“基于手术切除结果的放化疗治疗食管癌的指征和意义”，Cancer Clinic 50(2) (2004)。

安田卓司, 矢野雅彦, 他: "外科切除成績からみた食道癌治療における化学放射線療法の適応と意義"癌の臨床. (In press).

Takuji Yasuda、Masahiko Yano 等：“从手术切除结果的角度看放化疗治疗食管癌的适应症和意义”《临床癌症》（正在出版）。

Kishi K., Yasuda T., et al.: "Prediction of the response to chemoradiation and prognosis in oesophageal squamous cancer."British Journal of Surgery. 89. 597-603 (2002)

Kishi K.、Yasuda T. 等人：“食管鳞癌放化疗反应和预后的预测。”英国外科杂志。

Kishi K., Yasuda T., et al.: "Prediction of the response to chemoradiation and prognosis in oesophageal squamous cancer"British Journal of Surgery. 89.

Kishi K.、Yasuda T.等人：“食管鳞癌放化疗反应和预后的预测”英国外科杂志。