Wakatsuki Kohei, Matsumoto Sohei, Migita Kazuhiro, Ito Masahiro, Kunishige Tomohiro, Nakade Hiroshi, Nakatani Mitsuhiro, Kitano Mutsuko, Takano Masato, Obayashi Chiho, Sho Masayuki
Department of Surgery, Nara Medical University, Nara, Japan.
Department of Surgery, Nara Medical University, Nara, Japan.
Surgery. 2017 Oct;162(4):823-835. doi: 10.1016/j.surg.2017.06.003. Epub 2017 Jul 11.
In Japan, preoperative chemotherapy is considered essential for resectable stage II or III esophageal cancers. It is important to identify nonresponders for preoperative chemotherapy because continuing ineffective chemotherapy is not beneficial for them. We investigated the correlation between the computed tomography number of tumor and the effect of preoperative chemotherapy in patients with esophageal cancer.
This retrospective study included 50 patients receiving preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for stage II or III esophageal cancer. The computed tomography number of tumor was measured as the mean of Hounsfield Units of the primary lesion on a plain computed tomography measured within a freehand region of interest drawn around the tumor border. For analysis, the patients were classified into responders and nonresponders to chemotherapy, with the pathologic response evaluated using the Japanese and Mandard classification. We analyzed the associations between the computed tomography number of tumor and clinical factors; histopathologic features, including the tumor size, depth of tumor invasion, capillary invasion, Ki-67, p53, and CK5/6 expression; the pathologic response to chemotherapy and prognosis.
There was a significant association between the computed tomography number of tumor and the response to chemotherapy. The cut-off value of the computed tomography number of tumor in predicting responders to chemotherapy was 40 Hounsfield Units (area under the receiver operating characteristic curve = 0.73, P = .009); patients with computed tomography number of tumor greater than this value significantly responded to chemotherapy (P = .02 in the Japanese and P = .009 in the Mandard classification) with good postoperative prognosis (P = .04). Only Ki-67 expression among the histopathogic features were associated with the computed tomography number of tumor in histopathologic features (P = .01).
The computed tomography number of tumor may be useful to predict the efficacy of preoperative chemotherapy and subsequent prognosis for patients with advanced esophageal cancer.
在日本，术前化疗被认为是可切除的II期或III期食管癌的必要治疗手段。识别术前化疗无反应者很重要，因为持续进行无效的化疗对他们并无益处。我们研究了食管癌患者肿瘤的计算机断层扫描数值与术前化疗效果之间的相关性。
这项回顾性研究纳入了50例接受多西他赛、顺铂和5-氟尿嘧啶术前化疗的II期或III期食管癌患者。肿瘤的计算机断层扫描数值通过在肿瘤边界周围徒手绘制的感兴趣区域内测量的平扫计算机断层扫描上原发灶的亨氏单位平均值来测定。为进行分析，将患者分为化疗反应者和无反应者，使用日本和曼德尔分类法评估病理反应。我们分析了肿瘤的计算机断层扫描数值与临床因素、组织病理学特征（包括肿瘤大小、肿瘤浸润深度、微血管浸润、Ki-67、p53和CK5/6表达）、化疗的病理反应及预后之间的关联。
肿瘤的计算机断层扫描数值与化疗反应之间存在显著关联。肿瘤的计算机断层扫描数值预测化疗反应者的临界值为40亨氏单位（受试者工作特征曲线下面积 = 0.73，P = 0.009）；肿瘤计算机断层扫描数值大于该值的患者对化疗有显著反应（日本分类法中P = 0.02，曼德尔分类法中P = 0.009），术后预后良好（P = 0.04）。在组织病理学特征中，仅Ki-67表达与肿瘤的计算机断层扫描数值相关（P = 0.01）。
肿瘤的计算机断层扫描数值可能有助于预测晚期食管癌患者术前化疗的疗效及后续预后。
