内镜活检和超声内镜检查用于检测食管癌新辅助放化疗后的病理完全缓解：系统评价和荟萃分析。
Endoscopic biopsy and EUS for the detection of pathologic complete response after neoadjuvant chemoradiotherapy in esophageal cancer: a systematic review and meta-analysis.
机构信息
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
Gastrointest Endosc. 2016 May;83(5):866-79. doi: 10.1016/j.gie.2015.11.026. Epub 2015 Nov 26.
BACKGROUND AND AIMS
Accurate determination of residual cancer status after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer could assist in selecting the optimal treatment strategy. The aim of this study was to review the evidence on the diagnostic accuracy of endoscopic biopsy and EUS after nCRT for detecting residual cancer at the primary tumor site (ypT+) and regional lymph nodes (ypN+) as opposed to a pathologic complete response (ypT0 and ypN0).
METHODS
PubMed/Medline, Embase, and the Cochrane library were systematically searched. The analysis included diagnostic studies reporting on the accuracy of endoscopic biopsy or EUS in detecting residual cancer versus complete response after nCRT for esophageal cancer with histopathology as the reference standard. Bivariate random-effects models were used to estimate pooled sensitivities and specificities and examine sources of heterogeneity.
RESULTS
Twenty-three studies comprising 12 endoscopic biopsy studies (1281 patients), 11 EUS studies reporting on ypT status (593 patients), and 10 EUS studies reporting on ypN status (602 patients), were included. Pooled estimates for sensitivity of endoscopic biopsy after nCRT for predicting ypT+ were 34.5% (95% confidence interval [CI], 26.0%-44.1%) and for specificity 91.0% (95% CI, 85.6%-94.5%). Pooled estimates for sensitivity of EUS after nCRT were 96.4% (95% CI, 91.7%-98.5%) and for specificity were 10.9% (95% CI, 3.5%-29.0%) for detecting ypT+, and 62.0% (95% CI, 46.0%-75.7%) and 56.7% (95% CI, 41.8%-70.5%) for detecting ypN+, respectively.
CONCLUSIONS
Endoscopic biopsy after nCRT is a specific but not sensitive method for detecting residual esophageal cancer. Although EUS after nCRT yields a high sensitivity, only a limited number of patients will have negative findings at EUS with still a substantial false-negative rate. Furthermore, EUS provides only moderate accuracy for detecting residual lymph node involvement. Based on these findings, these endoscopic modalities cannot be used to withhold surgical treatment in test-negative patients after nCRT. (
CLINICAL TRIAL REGISTRATION NUMBER
CRD42015016527.).
背景与目的
准确判断新辅助放化疗（nCRT）后食管癌的残留癌状态有助于选择最佳治疗策略。本研究旨在综述 nCRT 后内镜活检和 EUS 检测原发肿瘤部位（ypT+）和区域淋巴结（ypN+）残留癌与病理完全缓解（ypT0 和 ypN0）的诊断准确性的证据。
方法
系统检索 PubMed/Medline、Embase 和 Cochrane 图书馆。纳入报告 nCRT 后内镜活检或 EUS 检测残留癌与组织病理学参考标准相比完全缓解的准确性的诊断研究。采用双变量随机效应模型估计汇总敏感性和特异性，并检查异质性来源。
结果
共纳入 23 项研究，包括 12 项内镜活检研究（1281 例患者）、11 项 EUS 研究报告 ypT 状态（593 例患者）和 10 项 EUS 研究报告 ypN 状态（602 例患者）。nCRT 后内镜活检预测 ypT+的汇总敏感性为 34.5%（95%置信区间 [CI]，26.0%-44.1%），特异性为 91.0%（95% CI，85.6%-94.5%）。nCRT 后 EUS 的汇总敏感性为 96.4%（95% CI，91.7%-98.5%），特异性为 10.9%（95% CI，3.5%-29.0%），用于检测 ypT+，用于检测 ypN+的敏感性分别为 62.0%（95% CI，46.0%-75.7%）和 56.7%（95% CI，41.8%-70.5%）。
结论
nCRT 后内镜活检特异性高但敏感性低，不能用于检测残留食管癌。虽然 nCRT 后 EUS 具有较高的敏感性，但只有少数患者 EUS 检查结果为阴性，且仍存在较高的假阴性率。此外，EUS 对检测残留淋巴结受累的准确性仅为中等。基于这些发现，这些内镜方法不能在 nCRT 后阴性患者中用于避免手术治疗。（临床试验注册号：CRD42015016527.）。
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