对考虑行食管癌切除术的患者进行术前非侵入性超声内镜评估。

Preoperative noninvasive EUS evaluation in patients with esophageal cancer considered for esophagectomy.

作者信息

Gheorghe Cristian, Stanescu Codrut, Gheorghe Liana, Bancila Ion, Herlea Vlad, Becheanu Gabriel, Voinea Daniela, Iacob Razvan, Lupescu Ioana, Anghel Rodica, Croitoru Adina, Popescu Irinel

机构信息

Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Str. Fundeni no. 258, 72437 Bucharest, Romania.

出版信息

J Gastrointestin Liver Dis. 2006 Jun;15(2):137-41.

PMID:16802008

Abstract

BACKGROUND

Worldwide, esophageal cancer ranks fifth in the mortality rate regarding tumor locations. EUS is an essential tool in the evaluation of these patients allowing accurate staging and permitting stratified treatment options. AIM. We have studied prospectively the impact of EUS in the evaluation and decision for therapy of patients with esophageal cancer diagnosed in our center.

MATERIAL AND METHODS

From March 2001 through March 2006, 220 patients were hospitalized at the Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, with the diagnosis of esophageal cancer. Out of the 220 patients, 41 patients, with no major comorbidities contraindicating esophagectomy already having been screened by abdominal and thoracic CT to disclose distant metastases, had EUS with the definite purpose of staging esophageal carcinoma and selecting adequate therapy. Assuming that without preoperative staging by EUS, all 41 patients in the study group would have been offered surgical treatment, we evaluated the number of patients and the modality in which EUS resulted in changes to the therapeutic plan.

RESULTS

Depth of invasion was recorded for the 41 patients as follows: T1 in 2 patients (4.9%), T2 in 6 patients (14.6%), T3 in 24 patients (58.5%), and T4 in 10 patients (22%). Regional lymph node (N) status as determined by EUS criteria was as follows: N0 in 7 patients (17%) and N1 in 34 patients (83%). Assessment of distant metastases (M) was recorded showing 4 patients with celiac axis lymph nodes metastases (M1). Preoperative EUS staging changed the decision for surgery in 18 of 41 patients (44%) (p<0.0001) and allowed primary esophagectomy in only 6 patients (15%) (p<0.0001). Compared to histopathology, the overall accuracy of EUS staging for pT1 and pT2 was 80% for staging pT3 and pT4 77% and for lymph node evaluation was approximately 75%.

CONCLUSION

Esophageal EUS offers useful information to clinicians caring for patients with esophageal cancer, impacts clinical decision making, and should be used in appropriate settings to plan patients' care.

摘要

背景

在全球范围内，食管癌的死亡率在肿瘤相关死因中位列第五。超声内镜检查（EUS）是评估此类患者的重要工具，它能实现精准分期，并为分层治疗方案提供依据。目的：我们前瞻性地研究了EUS对我院确诊的食管癌患者评估及治疗决策的影响。

材料与方法

2001年3月至2006年3月期间，220例诊断为食管癌的患者入住Fundeni临床研究所胃肠病与肝病中心。在这220例患者中，41例无严重合并症且无食管切除术禁忌证的患者，已通过腹部和胸部CT筛查以排除远处转移，他们接受EUS检查的明确目的是对食管癌进行分期并选择合适的治疗方法。假设研究组中所有41例患者在未进行术前EUS分期的情况下都将接受手术治疗，我们评估了EUS导致治疗方案改变的患者数量及方式。

结果

记录了41例患者的浸润深度如下：T1期2例（4.9%），T2期6例（14.6%），T3期24例（58.5%），T4期10例（22%）。根据EUS标准确定的区域淋巴结（N）状态如下：N0期7例（17%），N1期34例（83%）。记录的远处转移（M）评估显示，4例患者存在腹腔动脉淋巴结转移（M1）。术前EUS分期使41例患者中的18例（44%）改变了手术决策（p<0.0001），仅6例患者（15%）得以进行一期食管切除术（p<0.0001）。与组织病理学相比，EUS对pT1和pT2分期的总体准确率为80%，对pT3和pT4分期为77%，对淋巴结评估约为75%。