Brown W A, Thomas J, Gotley D, Burmeister B H, Lim K-H, Martin I, Walpole E T, Thomson D B, Harvey J A, Smithers B M
Upper Gastrointestinal Multidisciplinary Clinic, University of Queensland, Princess Alexandra Hospital, Buranda, Queensland, Australia.
Br J Surg. 2004 Feb;91(2):199-204. doi: 10.1002/bjs.4411.
Approximately 25 per cent of patients with oesophageal cancer who undergo neoadjuvant chemoradiotherapy have no evidence of tumour in the resected specimen (complete pathological response). Those who do not respond have a poor 5-year survival compared with complete responders, regardless of whether or not they undergo surgery. Selecting for surgery only those who have a response to neoadjuvant therapy has the potential to improve overall survival as well as to rationalize the management of non-responders. This study assessed the accuracy of oesophagogastroscopy in this setting.
A prospective database of 804 patients undergoing oesophageal resection for carcinoma was reviewed. Endoscopic assessment of the response to neoadjuvant therapy in 100 consecutive patients was compared with the pathological assessment of response. The survival for each level of response was compared.
At endoscopy 30 patients were considered to have had a complete response. This was confirmed pathologically in 15 patients. Survival was improved in those with a pathologically confirmed complete response (3-year survival rate 62.4 (s.e. 12.9) per cent) compared with non-responders (16.3 (s.e. 6.6) per cent). Those with microscopic residual disease also had an improved 3-year survival rate (46.3 (s.e. 12.2) per cent); however, oesophagogastroscopy failed to identify this subset.
Oesophagogastroscopy may be useful in the assessment of tumour response to neoadjuvant therapy. However, owing to its poor accuracy patients should not be excluded from further therapeutic intervention on the basis of this assessment alone.
接受新辅助放化疗的食管癌患者中，约25%的患者切除标本中无肿瘤证据（完全病理缓解）。无论是否接受手术，未缓解的患者与完全缓解者相比，5年生存率较差。仅选择对新辅助治疗有反应的患者进行手术，有可能提高总体生存率，并使对无反应者的管理更加合理。本研究评估了在这种情况下食管胃镜检查的准确性。
回顾了一个包含804例因食管癌接受食管切除术患者的前瞻性数据库。将连续100例患者对新辅助治疗反应的内镜评估与反应的病理评估进行比较。比较了每种反应水平的生存率。
在内镜检查中，30例患者被认为有完全缓解。其中15例经病理证实。与无反应者（16.3%（标准误6.6%））相比，病理证实完全缓解者的生存率有所提高（3年生存率为62.4%（标准误12.9%））。有微小残留病灶的患者3年生存率也有所提高（46.3%（标准误12.2%））；然而，食管胃镜检查未能识别出这一亚组。
食管胃镜检查可能有助于评估肿瘤对新辅助治疗的反应。然而，由于其准确性较差，不应仅基于此评估就将患者排除在进一步的治疗干预之外。
