新辅助放化疗后 CT-PET 和内镜评估能否预测食管癌的残留疾病？

Can CT-PET and Endoscopic Assessment Post-Neoadjuvant Chemoradiotherapy Predict Residual Disease in Esophageal Cancer?

机构信息

Department of Surgery, Trinity Healthcare Sciences Building, St. James's Hospital and Trinity College Dublin, Dublin, Ireland.

出版信息

Ann Surg. 2016 Nov;264(5):831-838. doi: 10.1097/SLA.0000000000001902.

DOI:10.1097/SLA.0000000000001902

PMID:27741010

Abstract

OBJECTIVE

The aim of this study is to assess CT-PET and endoscopic assessment postneoadjuvant chemoradiotherapy (nCRT) in predicting complete pathologic response (pCR) in locally advanced esophageal cancer (LAEC).

DESIGN

A prospective cohort study.

BACKGROUND

nCRT is increasingly standard of care in LAEC, with pCR a surrogate for excellent outcome. Predicting pCR before surgery, with metabolic imaging and endoscopy, may spare patients' operative intervention.

METHODS

One hundred thirty-eight consecutive patients [mean age 61 ± 8, 99 male (72%), 103 (75%) adenocarcinoma] underwent nCRT with CT-PET and endoscopy 4 to 6 weeks later, and surgery subsequently. A complete metabolic response (cMR) was defined as SUVmax of <4. A complete endoscopic response (cER) was no residual mucosal abnormality. The association of pCR with cMR and cER was analyzed.

RESULTS

pCR was achieved in 30 patients (22%); 37% SCC and 17% adenocarcinoma. A cMR was evident in 63 (46%), of whom 17 (27%) had a pCR and 17(27%) were ypN+. A cER was observed in 45 (33%). The Spearman correlation for cER and cMR was 0.066 (P = 0.479), for cER and pCR was 0.004 (P = 0.969), and cMR and pCR -0.120 (P = 0.160). The sensitivity, specificity, positive predictive value, and negative predictive value of cMR was 57%, 57%, 27%, and 82%, respectively, and for combined cMR and cER was 24%, 83%, 28%, and 79%, respectively.

CONCLUSIONS

The prediction of pCR through CT-PET and endoscopy independently or combined is limited by low sensitivity and poor positive predictive value. Protocols to avoid surgery in patients with apparent complete clinical complete based on these criteria should be adopted with considerable caution.

摘要

目的

本研究旨在评估 CT-PET 和内镜评估新辅助放化疗后（nCRT）在预测局部晚期食管癌（LAEC）完全病理缓解（pCR）中的作用。

设计

前瞻性队列研究。

背景

nCRT 是 LAEC 的标准治疗方法，pCR 是良好预后的替代指标。通过代谢成像和内镜检查在手术前预测 pCR，可以使患者避免手术干预。

方法

138 例连续患者[平均年龄 61±8 岁，99 名男性（72%），103 名（75%）腺癌]接受 nCRT 治疗，随后在 4 至 6 周后进行 CT-PET 和内镜检查，然后进行手术。完全代谢反应（cMR）定义为 SUVmax<4。完全内镜反应（cER）定义为无残留黏膜异常。分析 pCR 与 cMR 和 cER 的关系。

结果

30 例（22%）患者获得 pCR；其中鳞癌占 37%，腺癌占 17%。63 例（46%）患者出现 cMR，其中 17 例（27%）获得 pCR，17 例（27%）为 ypN+。45 例（33%）患者出现 cER。cER 与 cMR 之间的斯皮尔曼相关系数为 0.066（P=0.479），cER 与 pCR 之间的相关系数为 0.004（P=0.969），cMR 与 pCR 之间的相关系数为-0.120（P=0.160）。cMR 的灵敏度、特异性、阳性预测值和阴性预测值分别为 57%、57%、27%和 82%，而 cMR 和 cER 联合的灵敏度、特异性、阳性预测值和阴性预测值分别为 24%、83%、28%和 79%。