Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan.
Ann Surg. 2011 Feb;253(2):279-84. doi: 10.1097/SLA.0b013e318206824f.
To investigate the value of endoscopic biopsy in predicting the clinicopathological response and survival in patients with esophageal cancers who received chemoradiotherapy (CRT) alone or CRT followed by surgery.
Endoscopic biopsy examination after CRT for esophageal cancer has been used to confirm the presence of residual tumor before surgery, but there is little or no information on the clinical significance of the results of endoscopic biopsy in neoadjuvant or definitive CRT.
We studied 189 patients who underwent endoscopic biopsy after induction CRT (40 Gy) for esophageal cancer, consisting of 123 patients who received neoadjuvant CRT (40 Gy) followed by surgery and 66 patients who underwent definitive CRT (mostly more than 60 Gy). The correlations between the results of endoscopic biopsy and clinicopathological factors, including response to CRT and survival, were examined.
For neoadjuvant CRT, endoscopic biopsy findings correlated significantly with pathological tumor regression and lymph node involvement,although the majority of cases with negative biopsy (64%) displayed residual tumor cells in the surgical specimen. The 5-year survival rate was significantly higher in patients with negative biopsy (48.3%) than in those with positive biopsy (21.8%, P = 0.006). For definitive CRT, patients with negative biopsy at the time of 40 Gy showed clinical complete response to CRT (P = 0.002)and had significantly better 3-year survival (57.0%) than those with positive biopsy (22.5%, P = 0.0008).
The results of endoscopic biopsy examination after induction CRT can predict the response to CRT and prognosis of patients who receive CRT with and without surgery.
探讨内镜活检在预测单独接受放化疗（CRT）或 CRT 后手术的食管癌患者临床病理反应和生存方面的价值。
CRT 后对食管癌进行内镜活检检查已被用于在手术前确认肿瘤残留，但关于新辅助或根治性 CRT 内镜活检结果的临床意义的信息很少或没有。
我们研究了 189 例接受诱导性 CRT（40Gy）后行内镜活检的食管癌患者，其中 123 例接受新辅助 CRT（40Gy）后手术，66 例接受根治性 CRT（大多超过 60Gy）。检查内镜活检结果与包括 CRT 反应和生存在内的临床病理因素之间的相关性。
对于新辅助 CRT，内镜活检结果与病理肿瘤消退和淋巴结受累显著相关，尽管大多数阴性活检（64%）的病例在手术标本中仍显示残留肿瘤细胞。阴性活检患者的 5 年生存率（48.3%）显著高于阳性活检患者（21.8%，P=0.006）。对于根治性 CRT，在接受 40Gy 时阴性活检的患者对 CRT 有临床完全缓解（P=0.002），并且 3 年生存率明显高于阳性活检患者（57.0%对 22.5%，P=0.0008）。
诱导性 CRT 后内镜活检检查结果可预测接受 CRT 治疗（包括手术和不手术）患者的 CRT 反应和预后。
