Bohle Wolfram, Zachmann Ruben, Zoller Wolfram G
a Department of Gastroenterology , Katharinenhospital , Klinikum Stuttgart , Germany.
Scand J Gastroenterol. 2017 Jun-Jul;52(6-7):754-761. doi: 10.1080/00365521.2017.1303845. Epub 2017 Mar 30.
The accuracy of endosonographic tumor staging after neoadjuvant therapy is less reliable than in primary staging. Therefore, the value of sequential endosonographic examinations after neaodjuvant chemotherapy in gastro-esophageal cancer is discussed controversially. Previous data suggest, that endoscopic ultrasound (EUS) after neoadjuvant treatment using other variables than classic uTN-criteria may identify patients with a better prognosis.
In 67 patients with locally advanced gastric cancer treated in curative intent, we performed EUS before and after neoadjuvant chemotherapy. Endosonographic yTN-stage was compared to pathohistological yTN-stage after curative resection. The uTN-stage, yuTN-stage, maximal tumor thickness and maximal lymph node diameter as well as the shift of these variables after neoadjuvant therapy were analyzed for their usefulness to predict recurrence-free follow-up.
Accuracy of EUS for yTN-staging after neoadjuvant therapy was poor, especially in lower tumor stages. However, three heavily correlated variables analyzed by sequential EUS could be used for the prediction of prognosis: low endosonographic tumor stage (yuT0-2) after neoadjuvant chemotherapy, a decrease of two or more steps in uT-stage and a maximal tumor thickness of <15 mm after chemotherapy were significantly associated with recurrence-free follow-up. Endosonographic T-stage before neoadjuvant therapy, as well as lymph node variables before or after chemotherapy, were of no predictive value.
In spite of poor concordance between endosonographic and pathohistological TN-stage after neoadjuvant treatment, sequential EUS, performed before and after neoadjuvant therapy, possibly identify patients at risk for tumor relapse after multimodal treatment in gastric cancer. This finding should be validated in a larger patient cohort.
新辅助治疗后内镜超声肿瘤分期的准确性不如初次分期可靠。因此，新辅助化疗后序贯内镜超声检查在胃食管癌中的价值存在争议。既往数据表明，新辅助治疗后使用经典uTN标准以外的其他变量进行内镜超声（EUS）检查，可能识别出预后较好的患者。
对67例接受根治性治疗的局部进展期胃癌患者，在新辅助化疗前后进行EUS检查。将内镜超声yTN分期与根治性切除后的病理组织学yTN分期进行比较。分析uTN分期、yuTN分期、最大肿瘤厚度和最大淋巴结直径，以及新辅助治疗后这些变量的变化，以评估其预测无复发生存的效用。
新辅助治疗后EUS对yTN分期的准确性较差，尤其是在肿瘤分期较低的情况下。然而，序贯EUS分析的三个高度相关变量可用于预测预后：新辅助化疗后内镜超声肿瘤分期较低（yuT0 - 2）、uT分期下降两个或更多分期以及化疗后最大肿瘤厚度<15 mm与无复发生存显著相关。新辅助治疗前的内镜超声T分期以及化疗前后的淋巴结变量均无预测价值。
尽管新辅助治疗后内镜超声与病理组织学TN分期的一致性较差，但新辅助治疗前后进行的序贯EUS可能识别出胃癌多模式治疗后有肿瘤复发风险的患者。这一发现应在更大的患者队列中得到验证。
