Sarkaria Inderpal S, Rizk Nabil P, Bains Manjit S, Tang Laura H, Ilson David H, Minsky Bruce I, Rusch Valerie W
Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Ann Surg. 2009 May;249(5):764-7. doi: 10.1097/SLA.0b013e3181a38e9e.
Endoscopic biopsy after chemoradiation therapy (CRT) for esophageal cancer has been used to determine response to treatment. We wanted to determine if endoscopic biopsy can accurately establish evidence of local pathologic complete response (pCR) in patients undergoing CRT.
We queried a prospectively maintained database for patients seen at Memorial Sloan-Kettering Cancer Center from 1996 to the present who underwent, (1) CRT for local-regionally advanced esophageal cancer, (2) post-CRT endoscopic biopsy, and (3) esophagectomy. Data points included pathology of post-CRT endoscopy and surgical specimens, tumor histology, and survival. Correlations were analyzed by the chi2 test and one-way analysis of variance. Survival comparisons were assessed using the Kaplan-Meier method and log-rank analysis.
One hundred fifty-six patients were identified. Over 80% of patients received cisplatin-based chemotherapy and 5040 cGy of radiation. One hundred eighteen patients had no tumor identified on endoscopic biopsy. A negative biopsy at endoscopy was a poor predictor of pCR (negative predictive value: 31%), with 69% having local disease at esophagectomy. A positive biopsy was predictive of residual disease (positive predictive value: 95%). Negative endoscopic biopsy better predicted a pCR for squamous cell carcinomas versus adenocarcinomas (P[r] < 0.001). Nodal status of surgical specimens was not correlated with post-treatment endoscopic findings. Survival was equivalent after surgery in patients with a negative endoscopic biopsy versus patients with positive pathology.
A negative endoscopic biopsy is not a useful predictor of a pCR after CRT, final nodal status, or overall survival.
食管癌放化疗（CRT）后的内镜活检已被用于确定治疗反应。我们想确定内镜活检能否准确证实接受CRT的患者存在局部病理完全缓解（pCR）。
我们查询了纪念斯隆凯特琳癌症中心自1996年至今前瞻性维护的数据库，这些患者接受了：（1）针对局部晚期食管癌的CRT；（2）CRT后的内镜活检；（3）食管切除术。数据点包括CRT后内镜检查和手术标本的病理、肿瘤组织学及生存率。通过卡方检验和单因素方差分析进行相关性分析。使用Kaplan-Meier法和对数秩分析评估生存比较情况。
共识别出156例患者。超过80%的患者接受了以顺铂为基础的化疗和5040 cGy的放疗。118例患者在内镜活检中未发现肿瘤。内镜活检阴性对pCR的预测能力较差（阴性预测值：31%），69%的患者在食管切除术中存在局部病变。活检阳性可预测残留疾病（阳性预测值：95%）。与腺癌相比，内镜活检阴性对鳞状细胞癌pCR的预测性更好（P[r]<0.001）。手术标本的淋巴结状态与治疗后内镜检查结果无关。内镜活检阴性的患者与病理阳性的患者术后生存率相当。
内镜活检阴性对CRT后的pCR、最终淋巴结状态或总生存率并非有用的预测指标。
