Buenaventura P, Luketich J D
Section of Thoracic Surgery, University of Pittsburgh Medical Center Health System, Pennsylvania, USA.
Chest Surg Clin N Am. 2000 Aug;10(3):487-97.
The rising incidence of adenocarcinoma of the esophagus and the poor overall 5-year survival using current treatment regimens make it essential that clinical trials continue to search for more effective regimens for specific stages of esophageal cancer. It is clear from work in non-small cell lung cancer that clinical efficacy for platinum-based chemotherapeutic regimens has shown promise only in specific subsets of patients, such as those with stage IIIa tumors, but no benefit at all for earlier stages. In lung cancer, mediastinoscopy has been shown to be the most accurate method to stage locoregional lymph nodes and is considered to be the gold standard for clinical trials. In esophageal cancer, accurate surgical staging of all locoregional lymph nodes is more complex and may involve abdominal, thoracic, and cervical areas. Molecular evidence of lymph node involvement in esophageal cancer suggests that even histologically negative nodes may harbor micrometastases in a significant number of cases. Laparoscopy and thoracoscopy now offer a more accurate alternative to conventional staging of esophageal cancer. For distal esophageal cancers near the gastroesophageal junction, laparoscopic staging alone may suffice in most cases. Associated costs and the requirement for a surgical procedure should encourage the continued evaluation of new noninvasive modalities and the further evolution of endoscopic ultrasound. Currently, we recommend the application of minimally invasive surgical staging to assess new noninvasive technologies, such as PET scanning, and for use in clinical trials until the definitive approach to staging esophageal cancer is established. We are currently participating in an ongoing multicenter study of thoracoscopic and laparoscopic staging for esophageal cancer.
食管癌腺癌发病率不断上升，而采用目前的治疗方案总体5年生存率较低，这使得继续开展临床试验以寻找针对食管癌特定阶段更有效治疗方案变得至关重要。从非小细胞肺癌的研究工作中可以清楚地看到，铂类化疗方案的临床疗效仅在特定亚组患者中显示出前景，比如Ⅲa期肿瘤患者，但对早期患者则毫无益处。在肺癌中，纵隔镜检查已被证明是对区域淋巴结进行分期的最准确方法，并且被视为临床试验的金标准。在食管癌中，对所有区域淋巴结进行准确的手术分期更为复杂，可能涉及腹部、胸部和颈部区域。食管癌淋巴结受累的分子证据表明，在许多病例中，即使组织学检查为阴性的淋巴结也可能存在微转移。腹腔镜检查和胸腔镜检查现在为食管癌的传统分期提供了一种更准确的替代方法。对于靠近胃食管交界处的远端食管癌，大多数情况下仅腹腔镜分期可能就足够了。相关成本以及对手术操作的要求应促使继续评估新的非侵入性检查方法，并推动内镜超声的进一步发展。目前，我们建议应用微创外科分期来评估新的非侵入性技术，如PET扫描，并用于临床试验，直到确定食管癌分期的最终方法。我们目前正在参与一项正在进行的关于食管癌胸腔镜和腹腔镜分期的多中心研究。
