Schneider Paul M, Metzger Ralf, Schaefer Hartmut, Baumgarten Frank, Vallbohmer Daniel, Brabender Jan, Wolfgarten Eva, Bollschweiler Elfriede, Baldus Stephan E, Dienes Hans P, Hoelscher Arnulf H
Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
Ann Surg. 2008 Dec;248(6):902-8. doi: 10.1097/SLA.0b013e31818f3afb.
To prospectively assess the sensitivity (sens), specificity (spec), positive predictive value (ppv), negative predictive value (npv), and accuracy (acc) for clinical response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound (EUS) to determine histomorphologic regression UICC T-category downstaging after neoadjuvant chemoradiation for esophageal cancer.
Histomorphologic regression is meanwhile established as objective parameter for response and prognosis after neoadjuvant chemoradiation for esophageal cancer.
Within a prospective observation trial, 80 patients with localized esophageal cancers (cT2-4,Nx,M0) received standardized neoadjuvant chemoradiation (cisplatin, 5-fluorouracil, 36 Gy) and were resected by transthoracic en bloc esophagectomy and two-field lymphadenectomy. Tumor regression was based on the percentage of vital residual tumor cells and classified in 4 categories as reported previously. Evaluation by endoscopy and EUS was performed based on WHO/UICC criteria before starting chemoradiation and before resection and rebiopsies were taken at the time of re-endoscopy.
Histomorphologic response was of significant (log rank) prognostic importance (P < 0.001), whereas clinical response evaluation by endoscopy (P = 0.1), rebiopsy (P = 0.34), and EUS (P = 0.35) was not. The results of the 3 diagnostic modalities to assess histomorphologic regression by endoscopy and rebiopsy UICC ypT-category downstaging for EUS are summarized: Endoscopy: sens 60%, spec 34%, ppv 49%, npv 44%, acc 47%. Rebiopsy: sens 36%, spec 100%, ppv 100%, npv 24%, acc 47%. EUS: sens 7%, spec 79%, ppv 18%, npv 57%, acc 50%.
Histomorphologic regression is an objective response parameter of significant prognostic importance. The diagnostic accuracy of endoscopy, rebiopsy, and EUS is inadequate for objective response evaluation after neoadjuvant chemoradiation and can be omitted for this purpose in the clinical practice.
前瞻性评估内镜检查、再次活检及内镜超声（EUS）用于临床反应评估的敏感性（sens）、特异性（spec）、阳性预测值（ppv）、阴性预测值（npv）及准确性（acc），以确定食管癌新辅助放化疗后组织形态学消退及国际抗癌联盟（UICC）T分期降期情况。
组织形态学消退同时被确立为食管癌新辅助放化疗后反应及预后的客观参数。
在一项前瞻性观察试验中，80例局限性食管癌患者（cT2 - 4，Nx，M0）接受标准化新辅助放化疗（顺铂、5 - 氟尿嘧啶、36 Gy），并通过经胸整块食管切除术及二野淋巴结清扫术进行切除。肿瘤消退基于存活残留肿瘤细胞的百分比，如先前报道分为4类。在开始放化疗前、切除前根据世界卫生组织/国际抗癌联盟标准进行内镜检查和EUS评估，并在再次内镜检查时进行再次活检。
组织形态学反应具有显著（对数秩）预后重要性（P < 0.001），而内镜检查（P = 0.1）、再次活检（P = 0.34）及EUS（P = 0.35）的临床反应评估则不然。总结3种诊断方式用于评估内镜检查及再次活检的组织形态学消退以及EUS的UICC ypT分期降期情况的结果：内镜检查：敏感性60%，特异性34%，阳性预测值49%，阴性预测值44%，准确性47%。再次活检：敏感性36%，特异性100%，阳性预测值100%，阴性预测值
