Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Endoscopy. 2017 Oct;49(10):941-948. doi: 10.1055/s-0043-112492. Epub 2017 Jun 21.
Treatment strategies for clinical (c)T2N0M0 esophageal adenocarcinoma (EAC) are subject to debate owing to the relative inaccuracy of tumor staging by endoscopic ultrasound (EUS), with profound implications in overstaged patients. We aimed to evaluate the final histological diagnosis of patients initially staged as having a cT2 tumor by EUS, and to assess the value of endoscopic reassessment by an interventional endoscopist, followed by an endoscopic resection when deemed feasible. Two distinct cohorts of patients with cT2 EAC as determined by EUS were included: a retrospective surgical cohort of patients treated by primary esophagectomy, and a prospective cohort of patients who underwent an endoscopic reassessment by an interventional endoscopist. The main outcome measure was the final pathological (p)T stage. We identified 134 patients with stage T2 EAC from the surgical cohort. In 72 patients treated by primary esophagectomy, 32/72 (44 %) were downstaged to a pT1 tumor. In 12/72 (17 %), the surgical resection specimen showed tumor characteristics that fulfilled the current criteria for a curative endoscopic resection. In 13 prospectively identified patients with cT2N0M0 EAC, an expert endoscopic reassessment was done. In 11/13 (85 %) the lesion appeared endoscopically resectable and a complete endoscopic resection was performed. Histology revealed a pT1 tumor in all 11 patients, with 5/13 (38 %) fulfilling current criteria for a curative endoscopic resection. In this study, 44 % of cT2 EACs were in fact pT1 tumors. Curative treatment by endoscopic resection was achieved in more than a third of these cases. To avoid an unnecessary esophagectomy, an endoscopic reassessment by an interventional endoscopist is recommended for all patients with cT2N0M0 EAC.
治疗临床 (c)T2N0M0 食管腺癌 (EAC) 的策略因内镜超声 (EUS) 对肿瘤分期的相对不准确性而存在争议，这对过度分期的患者有深远影响。我们旨在评估最初通过 EUS 分期为 cT2 肿瘤的患者的最终组织学诊断，并评估介入内镜医生进行内镜再评估的价值，当认为可行时进行内镜切除。
EUS 确定的两个不同队列的 cT2 EAC 患者包括：接受原发性食管切除术治疗的回顾性手术队列和接受介入内镜医生内镜再评估的前瞻性队列。主要观察指标是最终的病理 (p)T 分期。
我们从手术队列中确定了 134 名 T2EAC 患者。在 72 名接受原发性食管切除术的患者中，32/72（44%）降期为 pT1 肿瘤。在 12/72（17%）例中，手术切除标本显示符合当前标准的肿瘤特征，可进行根治性内镜切除。在 13 名前瞻性确定的 cT2N0M0 EAC 患者中，进行了专家内镜再评估。在 11/13（85%）例中，病变内镜下可切除，并进行了完全内镜切除。组织学显示所有 11 例患者均为 pT1 肿瘤，其中 5/13（38%）例符合当前标准的根治性内镜切除。
在这项研究中，44%的 cT2 EAC 实际上是 pT1 肿瘤。在这些病例中，超过三分之一通过内镜切除术达到了根治性治疗。为避免不必要的食管切除术，建议对所有 cT2N0M0 EAC 患者进行介入内镜医生的内镜再评估。
