内镜超声定义的胸腔、心包或腹腔积液对食管癌的预后意义。

Prognostic significance of endoscopic ultrasound-defined pleural, pericardial or peritoneal fluid in oesophageal cancer.

机构信息

South East Wales Cancer Network, University Hospital of Wales, Cardiff, UK.

出版信息

Surg Endosc. 2009 Oct;23(10):2229-36. doi: 10.1007/s00464-008-0286-1. Epub 2009 Jan 1.

DOI:10.1007/s00464-008-0286-1

PMID:19118422

Abstract

BACKGROUND

Endoscopic ultrasound (EUS) is known to detect smaller effusion volumes than computerised tomography (CT), yet the outcomes for patients diagnosed with oesophageal carcinoma and EUS-defined pleural, pericardial or ascitic fluid effusions (EDFE) are unknown. The aim of this study was to determine the outcome of multidisciplinary stage directed treatment for such patients.

METHODS

Forty-nine (9.2%) out of a consecutive 527 patients diagnosed with oesophageal cancer from a single regional upper gastrointestinal (GI) cancer network were found to have evidence of EDFE undetected by CT. Thirty-nine (79.6%) patients had pleural effusions, eight (16.3%) pericardial effusions, and two (4.1%) ascites.

RESULTS

Twelve (24.4%) underwent surgery, 3 (6.1%) received neoadjuvant chemotherapy without subsequent surgery, 12 (24.5%) received definitive chemoradiotherapy (dCRT), and 22 (44.9%) received palliative treatment. Survival in patients with EDFE was significantly shorter (median and 2-year survival 15.6 months and 24%, respectively) when compared with patients without EDFE (26.7 months and 40%, respectively, p = 0.001), and was unrelated to EDFE type (p = 0.192). Two-year survival after oesophagectomy with or without neoadjuvant therapy was 45% in patients with EDFE compared with 42% in patients without EDFE (p = 0.668).

CONCLUSIONS

EDFE was an important adverse prognostic indicator, but patients deemed to have operable tumours should still be treated with radical intent.

摘要

背景

与计算机断层扫描（CT）相比，内镜超声（EUS）可检测到更小的胸腔积液量，但对于被诊断为食管癌且存在 EUS 定义的胸腔、心包或腹水积液（EDFE）的患者，其预后尚不清楚。本研究旨在确定针对此类患者进行多学科分期指导治疗的结果。

方法

在一个单区域上消化道（GI）癌症网络中，连续诊断出的 527 例食管癌患者中有 49 例（9.2%）发现存在 CT 未检测到的 EDFE。39 例（79.6%）患者存在胸腔积液，8 例（16.3%）患者有心包积液，2 例（4.1%）患者有腹水。

结果

12 例（24.4%）患者接受了手术，3 例（6.1%）患者在没有随后手术的情况下接受了新辅助化疗，12 例（24.5%）患者接受了根治性放化疗（dCRT），22 例（44.9%）患者接受了姑息治疗。与没有 EDFE 的患者相比，存在 EDFE 的患者的生存时间明显更短（中位和 2 年生存率分别为 15.6 个月和 24%）（分别为 26.7 个月和 40%，p=0.001），且与 EDFE 类型无关（p=0.192）。存在 EDFE 的患者在接受或不接受新辅助治疗的食管癌手术后的 2 年生存率为 45%，而不存在 EDFE 的患者的 2 年生存率为 42%（p=0.668）。