Machlenkin Svetlana, Melzer Ehud, Idelevich Efraim, Ziv-Sokolovsky Nadia, Klein Yoram, Kashtan Hanoch
Department of Surgery, Kaplan Medical Center and Hebrew University-Hadassah Medical School, Rehovot, Israel.
Isr Med Assoc J. 2009 Mar;11(3):166-9.
The role of endoscopic ultrasound in evaluating the response of esophageal cancer to neoadjuvant chemotherapy is controversial.
To evaluate the accuracy of EUS in restaging patients who underwent NAC.
The disease stage of patients with esophageal cancer was established by means of the TNM classification system. The initial staging was determined by chest and abdominal computed tomography and EUS. Patients who needed NAC underwent a preoperative regimen consisting of cisplatin and fluouracil. Upon completion of the chemotherapy, patients were restaged and then underwent esophagectomy. The results of the EUS staging were compared with the results of the surgical pathology staging. This comparison was done in two groups of patients: the study group (all patients who received NAC) and the control group (all patients who underwent primary esophagectomy without NAC).
NAC was conducted in 20 patients with initial stage IIB and III carcinoma of the esophagus (study group). Post-chemotherapy EUS accurately predicted the surgical pathology stage in 6 patients (30%). Pathological down-staging was noted in 8 patients (40%). However, the EUS was able to observe it in only 2 patients (25%). The accuracy of EUS in determining the T status alone was 80%. The accuracy for N status alone was 35%. In 65% of examinations the EUS either overestimated (35%) or underestimated (30%) the N status. Thirteen patients with initial stage I-IIA underwent primary esophagectomy after the initial staging (control group). EUS accurately predicted the surgical pathology disease stage in 11 patients (85%).
EUS is an accurate modality for initial staging of esophageal carcinoma. However, it is not a reliable tool for restaging esophageal cancer after NAC and it cannot predict response to chemotherapy.
内镜超声在评估食管癌新辅助化疗反应中的作用存在争议。
评估内镜超声（EUS）对接受新辅助化疗（NAC）患者再分期的准确性。
采用TNM分类系统确定食管癌患者的疾病分期。初始分期通过胸部和腹部计算机断层扫描及EUS确定。需要NAC的患者接受由顺铂和氟尿嘧啶组成的术前方案。化疗完成后，对患者进行再分期，然后进行食管切除术。将EUS分期结果与手术病理分期结果进行比较。在两组患者中进行了这种比较：研究组（所有接受NAC的患者）和对照组（所有未接受NAC而接受原发性食管切除术的患者）。
对20例初始为IIB期和III期食管癌的患者进行了NAC（研究组）。化疗后EUS准确预测了6例患者（30%）的手术病理分期。8例患者（40%）出现病理降期。然而，EUS仅能观察到2例患者（25%）的降期情况。EUS单独确定T分期的准确性为80%。单独确定N分期的准确性为35%。在65%的检查中，EUS对N分期的判断要么高估（35%）要么低估（30%）。13例初始为I-IIA期的患者在初始分期后接受了原发性食管切除术（对照组）。EUS准确预测了11例患者（85%）的手术病理疾病分期。
EUS是食管癌初始分期的一种准确方法。然而，它不是NAC后食管癌再分期的可靠工具，也不能预测化疗反应。
