Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
Cancer. 2012 Jan 15;118(2):349-57. doi: 10.1002/cncr.26301. Epub 2011 Jun 30.
In the seventh edition of the American Joint Committee on Cancer (AJCC) staging system for esophageal cancer, tumor grade was introduced as an independent determinant of stage grouping in early stage tumors. With the significantly lower prognosis for poorly differentiated early stage adenocarcinomas, patients with these tumors may become candidates for neoadjuvant therapy given an accurate identification of these tumors with preoperative staging. The objective of the current study was to investigate the accuracy of preoperative histopathologic grading and the effect of preoperative grade on tumor stage/prognostic grouping.
Preoperative tumor grade was compared with postoperative tumor grade in 427 patients who underwent surgery without receiving neoadjuvant therapy for adenocarcinoma of the esophagus. The impact of preoperative tumor grade on stage/prognostic grouping was investigated.
The overall accuracy of preoperative tumor grade assessment was 76% when unknown differentiation was regarded as well/moderately differentiated as recommended by the AJCC, whereas accuracy was 73% after the exclusion of tumors with unknown grade. In patients who have tumors classified as T1 or T2 and lymph node-negative (N0) (T1-T2N0) disease, 16% were assigned to a lower stage group based on preoperative pathology, whereas 5% were assigned to a higher stage group. In the T1-T2N0 group, sensitivity for detecting a poorly differentiated tumor was 0.43 (95% confidence interval [CI], 0.30-0.56), whereas specificity was 0.94 (95% CI, 0.90-0.98).
With increasing use of neoadjuvant therapy, the accuracy of preoperative biopsy assessment has become increasingly important. In the current study, the accuracy of preoperative tumor grade assessment was 73%, leading to changes in AJCC stage/prognostic group in 21% of patients with T1-T2N0 esophageal adenocarcinomas. The authors concluded that caution should be exhibited in staging patients with esophageal adenocarcinoma based on preoperative biopsy data.
在第七版美国癌症联合委员会（AJCC）食管癌分期系统中，肿瘤分级被引入作为早期肿瘤分期分组的独立决定因素。由于低分化早期腺癌的预后明显较差，对于这些肿瘤，如果能够通过术前分期准确识别，这些患者可能成为新辅助治疗的候选者。本研究的目的是探讨术前组织病理学分级的准确性以及术前分级对肿瘤分期/预后分组的影响。
对 427 例未接受新辅助治疗的食管腺癌患者进行手术，比较术前肿瘤分级与术后肿瘤分级。研究了术前肿瘤分级对分期/预后分组的影响。
当按照 AJCC 的建议将未知分化视为低/中分化时，术前肿瘤分级评估的总准确率为 76%，而排除未知分级的肿瘤后，准确率为 73%。在 T1 或 T2 且淋巴结阴性（N0）（T1-T2N0）的患者中，16%的患者根据术前病理被分到较低的分期组，而 5%的患者被分到较高的分期组。在 T1-T2N0 组中，检测低分化肿瘤的敏感性为 0.43（95%置信区间[CI]，0.30-0.56），特异性为 0.94（95% CI，0.90-0.98）。
随着新辅助治疗的广泛应用，术前活检评估的准确性变得越来越重要。在本研究中，术前肿瘤分级评估的准确性为 73%，导致 21%的 T1-T2N0 食管腺癌患者 AJCC 分期/预后分组发生变化。作者认为，基于术前活检数据对食管腺癌患者进行分期时应谨慎。
