Santa Casa de São Paulo, São Paulo, Brazil.
Endosc Ultrasound. 2014 Apr;3(Suppl 1):S15-6.
The objective of this case series study by retrospective analysis was to determine the relevance of endoscopic ultrasound (EUS) in therapeutic decision esophageal cancer.
Using medical records of the Department of Endoscopy of Santa Casa de São Paulo, we have collected data from 16 patients, in 4 years, diagnosed of esophageal cancer, and presented in the form of clinical cases to a specialist surgeon in esophageal cancer and a clinical oncologist, for therapeutic evaluation before and after the outcome of EUS.
Both of them choose non-resective and not curative methods (68.8% by surgeon vs. 87.5% oncologist) before EUS. The best treatment by the surgeon was chemotherapy and palliative radiotherapy associated (25%) and palliative endoscopic prostheses (25%), and by the oncologist, neoadjuvant chemotherapy and radiotherapy associated (56.2%). After EUS, the resective surgical treatment was the both choice in only 6.2% of cases, and the rest of 93.8%, non-resective. The surgeon choice was chemotherapy and palliative radiotherapy associated (44%), and oncologist choice was neoadjuvant chemotherapy and radiotherapy associated (44%). Analysis by the Chi-square method, comparing respective versus non-resective treatment, surgeon versus oncologist, with and without the EUS, obtained values of P = 0.39 and P = 0.46, respectively. The comparison between healing and non-healing treatment had the same P value. Regarding the change in behavior (resective vs. non-resective), there was a change of approach by the surgeon in 25% of cases (P = 0.17) and the oncologist moved conduct in 6.25% of cases. Comparing the changing of behavior among experts, the P value was 0.33. Despite evidence of behavior change after the EUS, the statistical point of view, the P value had no significant relevance. The main factor involved is probably due to a reduced number of sample cases. However, this is a pilot study, and is needed other with a larger number of cases.
The data obtained allow us to conclude that EUS proved to be an important test for the change in staging and therapeutic management of esophageal cancer.
本回顾性病例系列研究的目的是确定内镜超声（EUS）在食管癌治疗决策中的相关性。
我们使用圣卡塔琳娜州立医院内镜科的病历，收集了 4 年内被诊断为食管癌并以临床病例形式呈现给食管癌症专家外科医生和临床肿瘤学家的 16 名患者的数据，用于在 EUS 前后进行治疗评估。
在 EUS 之前，他们都选择了非切除术和非治愈方法（外科医生 68.8%，肿瘤学家 87.5%）。外科医生的最佳治疗方法是化疗和姑息性放疗联合（25%）和姑息性内镜支架（25%），而肿瘤学家的最佳治疗方法是新辅助化疗和放疗联合（56.2%）。EUS 后，仅 6.2%的病例选择了可切除的手术治疗，其余 93.8%的病例为非切除术。外科医生的选择是化疗和姑息性放疗联合（44%），肿瘤学家的选择是新辅助化疗和放疗联合（44%）。通过卡方检验方法，比较各自的非切除术治疗与非切除术治疗，外科医生与肿瘤学家，有和没有 EUS，分别获得 P = 0.39 和 P = 0.46 的值。治疗效果的比较也具有相同的 P 值。关于治疗行为的改变（可切除与非可切除），外科医生有 25%的病例改变了治疗方法（P = 0.17），肿瘤学家有 6.25%的病例改变了治疗方法。比较专家之间行为改变的情况，P 值为 0.33。尽管 EUS 后有行为改变的证据，但从统计学角度来看，P 值没有显著相关性。涉及的主要因素可能是由于样本病例数量较少。然而，这是一项初步研究，需要更多的病例进行研究。
获得的数据使我们能够得出结论，EUS 被证明是改变食管癌分期和治疗管理的重要检测手段。
