Cen Putao, Hofstetter Wayne L, Lee Jeffery H, Ross William A, Wu Tsung-Teh, Swisher Stephen G, Davila Marta, Rashid Asif, Correa Arlene M, Ajani Jaffer A
Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2008 Feb 1;112(3):503-10. doi: 10.1002/cncr.23217.
With increasing emphasis on endoscopic therapy (ET) for T1 esophageal carcinoma, the identification of low-risk patients is critical. It was hypothesized that endoscopic ultrasonography (EUS) in concert with detailed histopathologic evaluation would identify low-risk cancers for an appropriate but organ-preserving strategy.
All patients who had pretreatment EUS and underwent esophagectomy as primary therapy for esophageal cancer between 1999 and 2006 were analyzed retrospectively. The accuracy of EUS in predicting the correct pathologic stage was assessed along with a histopathologic reevaluation including lymphovascular invasion (LVI). Pathologic stage and various features were incorporated into a multivariate logistic regression model.
A total of consecutive 87 esophageal cancer patients (81 with adenocarcinoma) were evaluable for this analysis. EUS correctly diagnosed 59 T1 cancers and 20 T2-4 cancers but understaged cancers in 2 patients and overstaged cancers in 6 patients. EUS correctly identified 8 patients with lymph node metastases but not 13 other patients. The accuracy, sensitivity, and specificity of EUS for T1 cancers were 91%, 91%, and 91%, respectively; for T1a (intramucosal) cancers, the accuracy, sensitivity, and specificity were: 82%, 67%, and 93%, respectively, and for lymph node involvement these same values were 81%, 38%, and 94%, respectively. LVI was found to be an independent predictor of lymph node metastases on the multivariate analysis (P = .02).
Data from the current study demonstrate that EUS has excellent accuracy, sensitivity, and specificity (91% each) for identifying T1 esophageal cancers and LVI is an independent predictor of lymph node metastases. A strategy for preservation of the esophagus may be possible in patients who have EUS-designated T1 cancer without LVI after successful ET.
随着对T1期食管癌内镜治疗（ET）的重视日益增加，识别低风险患者至关重要。据推测，内镜超声检查（EUS）与详细的组织病理学评估相结合，将能够识别出适合采用保留器官策略的低风险癌症。
回顾性分析1999年至2006年间所有接受过术前EUS检查并作为食管癌主要治疗手段接受食管切除术的患者。评估EUS预测正确病理分期的准确性，并进行包括淋巴管侵犯（LVI）的组织病理学重新评估。将病理分期和各种特征纳入多变量逻辑回归模型。
本分析共纳入87例连续性食管癌患者（81例腺癌）。EUS正确诊断出59例T1期癌症和20例T2-4期癌症，但有2例癌症分期过低，6例癌症分期过高。EUS正确识别出8例有淋巴结转移的患者，但未识别出其他13例患者。EUS对T1期癌症的准确性、敏感性和特异性分别为91%、91%和91%；对于T1a（黏膜内）期癌症，准确性、敏感性和特异性分别为82%、67%和93%，对于淋巴结受累情况，相应的值分别为81%、38%和94%。在多变量分析中，LVI被发现是淋巴结转移的独立预测因素（P = 0.02）。
本研究数据表明，EUS在识别T1期食管癌方面具有出色的准确性、敏感性和特异性（均为91%），且LVI是淋巴结转移的独立预测因素。对于经EUS判定为无LVI的T1期癌症患者，在成功进行ET后，有可能采取保留食管的策略。
