Department of Surgery, Montefiore Einstein Center for Cancer Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
Albert Einstein College of Medicine, New York, New York.
J Surg Oncol. 2016 Jan;113(1):42-5. doi: 10.1002/jso.24098. Epub 2016 Jan 19.
Recent evidence validates the effectiveness of neoadjuvant chemotherapy in the treatment of gastric adenocarcinoma. Endoscopic ultrasonographic (EUS) staging has been proposed as a useful adjunct in this setting.
We performed a retrospective review of patients treated at our institution for gastric adenocarcinoma between July 2005 and January 2014. We identified patients referred for EUS before surgery as part of a prospective treatment plan. Histopathologic staging was compared to EUS staging, with a focus on T- and N-stage. Agreement between the two modalities was examined using kappa-statistics.
We identified 614 patients with biopsy-proven gastric adenocarcinoma; 145 underwent curative-intent surgery. Surgical pathology and EUS results were available from 69 patients. The accuracy of EUS for the evaluation of T- and N-stage was 44.9% and 56.5%, respectively. EUS demonstrated greater concordance with histopathology at evaluating T-stage (κ = 0.3469) than N-stage (κ = 0.1316). EUS underestimated T- and N-stage in 40.8% and 30.4% of patients, respectively.
EUS seems to correlate poorly with pathology in the preoperative staging of gastric adenocarcinoma. In the majority of inaccurate cases, EUS underestimates T-stage and N-stage, limiting its utility in the neoadjuvant setting.
近期有证据表明新辅助化疗在治疗胃腺癌方面的有效性。内镜超声（EUS）分期已被提出作为该治疗环境下的一种有用的辅助手段。
我们对 2005 年 7 月至 2014 年 1 月期间在我院治疗的胃腺癌患者进行了回顾性研究。我们确定了在手术前因治疗计划而接受 EUS 检查的患者。将组织病理学分期与 EUS 分期进行比较，重点关注 T 分期和 N 分期。使用 Kappa 统计检验评估两种方法之间的一致性。
我们共确定了 614 例经活检证实的胃腺癌患者，其中 145 例接受了根治性手术。有 69 例患者的手术病理和 EUS 结果可供分析。EUS 评估 T 分期和 N 分期的准确性分别为 44.9%和 56.5%。EUS 在评估 T 分期时与组织病理学的一致性更高（κ=0.3469），而在评估 N 分期时的一致性较低（κ=0.1316）。EUS 分别低估了 40.8%和 30.4%的患者的 T 分期和 N 分期。
EUS 似乎与胃腺癌的术前分期病理相关性较差。在大多数不准确的病例中，EUS 低估了 T 分期和 N 分期，限制了其在新辅助治疗环境中的应用。
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