Tsujimoto Hironori, Ichikura Takashi, Aiko Satoshi, Yaguchi Yoshihisa, Kumano Isao, Takahata Risa, Matsumoto Yusuke, Yoshida Kazumichi, Ono Satoshi, Yamamoto Junji, Hase Kazuo
Department of Surgery, National Defense Medical College, Tokorozawa 359-8513, Japan.
Exp Ther Med. 2012 Feb;3(2):243-248. doi: 10.3892/etm.2011.386. Epub 2011 Nov 22.
The objective of this study was to evaluate the multidetector computed tomography (MDCT) attenuation value between the tumor and aorta in response to the induction therapy for esophageal cancer. In advanced esophageal cancer, the main reason for unresectability is the local invasion of the tumor into the aorta or trachea. Despite remarkable advances in diagnostic modalities, pre-operative assessment of pathological response and local tumor extent in esophageal cancer remains difficult. MDCT attenuation values between the tumor and aorta, and the contact angle of the tumor to the aorta (Picus' angle) were retrospectively evaluated in patients with esophageal cancer who underwent induction therapy in terms of predicting the pathological response, aortic invasion and prognosis of esophageal cancer. The induction therapy may increase the tumor-to-aorta distance and decrease the maximum tumor size and Picus' angle. When the tumor-to-aorta cut-off value was set at <1.3 mm, the accuracy of this distance for aortic invasion was 94.6%. In terms of this distance, 14 out of 19 patients with a tumor-to-aorta distance of <1.3 mm prior to the induction therapy had a distance of >1.3 mm following therapy and underwent curative resection. The assessment of the MDCT attenuation value between the esophageal tumor and the aorta is simple and objectively assesses the response to the induction therapy and aortic invasion in esophageal cancer. This method should be applied to predict the response to the induction therapy and to prevent unnecessary surgery in patients with tumors involving the aorta.
本研究的目的是评估多排螺旋计算机断层扫描（MDCT）在食管癌诱导治疗后肿瘤与主动脉之间的衰减值。在晚期食管癌中，无法切除的主要原因是肿瘤局部侵犯主动脉或气管。尽管诊断方式有了显著进展，但食管癌术前病理反应和局部肿瘤范围的评估仍然困难。对接受诱导治疗的食管癌患者的肿瘤与主动脉之间的MDCT衰减值以及肿瘤与主动脉的接触角（皮库斯角）进行回顾性评估，以预测食管癌的病理反应、主动脉侵犯和预后。诱导治疗可能会增加肿瘤与主动脉的距离，减小最大肿瘤大小和皮库斯角。当肿瘤与主动脉的临界值设定为<1.3 mm时，该距离对主动脉侵犯的诊断准确率为94.6%。就该距离而言，19例诱导治疗前肿瘤与主动脉距离<1.3 mm的患者中有14例在治疗后距离>1.3 mm并接受了根治性切除。评估食管肿瘤与主动脉之间的MDCT衰减值简单易行，可客观评估食管癌诱导治疗的反应和主动脉侵犯情况。该方法应用于预测诱导治疗的反应，并防止对累及主动脉的肿瘤患者进行不必要的手术。
