Guo Tao, Yao Fang, Yang Ai-ming, Li Xiao-yi, Zhong Ding-rong, Wu Dong-sheng, Wu Xi, Lu Xing-hua
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Asia Pac J Clin Oncol. 2014 Jun;10(2):e28-32. doi: 10.1111/ajco.12045. Epub 2012 Dec 21.
To evaluate the role of endoscopic ultrasound (EUS) in restaging and predicting response after neoadjuvant chemotherapy in patients with advanced gastric cancer.
In all, 48 advanced gastric cancer patients were recruited from June 2007 to December 2010 after providing their written, informed consent. All patients underwent an EUS before and after three cycles of neoadjuvant chemotherapy (FOLFOX 6), and then a radical resection was performed 3-4 weeks after chemotherapy. The results of EUS were compared to the pathological results of the resected specimens.
After chemotherapy, the overall sensitivity of EUS for T classification was 63 percent (T2: 44%, T3: 68%, T4: 90%), and overstaging (31%) was more frequent than understaging (6%). The sensitivity and specificity of EUS for N classification were 56 and 50 percent, respectively (N0: without lymph node metastasis, N1: with lymph node metastasis), with 15 percent overstaged and 32% understaged. EUS revealed that T and/or N downstaging occurred in 46 percent (22/48) of patients after chemotherapy, most of whom had a favorable pathological response to the chemotherapy compared with other patients without T and/or N downstaging. No T or N upstaging was observed after neoadjuvant chemotherapy.
The accuracy of restaging by EUS for T and N classification was not as good as pathological data for locally advanced gastric cancer patients after neoadjuvant chemotherapy. However, T and/or N downstaging confirmed by EUS correlated well with the degree of pathological response to chemotherapy.
评估内镜超声（EUS）在晚期胃癌患者新辅助化疗后再分期及预测反应中的作用。
2007年6月至2010年12月，共招募了48例晚期胃癌患者，患者均签署了书面知情同意书。所有患者在接受三个周期的新辅助化疗（FOLFOX 6）前后均接受了EUS检查，然后在化疗后3 - 4周进行根治性切除术。将EUS结果与切除标本的病理结果进行比较。
化疗后，EUS对T分期的总体敏感性为63%（T2：44%，T3：68%，T4：90%），分期过高（31%）比分期过低（6%）更常见。EUS对N分期的敏感性和特异性分别为56%和50%（N0：无淋巴结转移，N1：有淋巴结转移），分期过高15%，分期过低32%。EUS显示，化疗后46%（22/48）的患者出现T和/或N分期降低，与其他未出现T和/或N分期降低的患者相比，这些患者中的大多数对化疗有良好的病理反应。新辅助化疗后未观察到T或N分期升高。
对于新辅助化疗后的局部晚期胃癌患者，EUS再分期对T和N分类的准确性不如病理数据。然而，EUS确认的T和/或N分期降低与化疗的病理反应程度密切相关。
