Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
Department of Pathology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
Eur J Cardiothorac Surg. 2018 Jan 1;53(1):201-208. doi: 10.1093/ejcts/ezx261.
Recent advances in neoadjuvant chemoradiotherapy (nCRT) have significantly increased the rates of pathological complete response achieved by patients with oesophageal cancer. Consequently, a watchful waiting strategy based on 'active endoscopic surveillance and surgery as needed' has been proposed for cases without clinical evidence of disease after neoadjuvant chemoradiotherapy. Here, we investigated whether endoscopic surveillance is a reliable tool for the detection of the initially unidentified residual cancer in this patient group.
We performed a careful pathological re-review of all cases with oesophageal squamous cell carcinoma, who attained a clinical complete response, despite showing a pathological non-complete response. The detailed anatomical locations of such unidentified malignancies were investigated in each patient to determine the prevalence of cancer involvement for each oesophageal layer.
Among the 73 patients with clinical complete response, 46 (63%) patients were found to have pathological non-complete response. The majority (89.1%; n = 41) of patients had evidence of residual cancer in the oesophagus, whereas only 5 (10.9%) patients had T0N+ disease. However, a high percentage (39.1%; n = 16) of patients had no detectable cancer in the mucosa and 9 of them also had no detectable cancer in sub-mucosal layer, ultimately hampering their detection via endoscopic biopsy.
Nearly 40% of patients with oesophageal squamous cell carcinoma who attained clinical complete response but showed a pathological non-complete response had residual cancer hidden underneath a cancer-free mucosa layer.
新辅助放化疗（nCRT）的最新进展显著提高了食管癌患者达到病理完全缓解的比例。因此，对于新辅助放化疗后无疾病临床证据的病例，提出了一种基于“主动内镜监测和必要时手术”的观察等待策略。在这里，我们研究了内镜监测是否是检测这组患者中最初未被识别的残留癌症的可靠工具。
我们对所有临床完全缓解但病理不完全缓解的食管鳞状细胞癌患者进行了仔细的病理复查。在每个患者中调查这些未被识别的恶性肿瘤的详细解剖位置，以确定每个食管层的癌症受累的普遍性。
在 73 例临床完全缓解的患者中，有 46 例（63%）患者病理不完全缓解。大多数（89.1%；n=41）患者的食管有残留癌的证据，而仅有 5 例（10.9%）患者有 T0N+疾病。然而，有相当高比例（39.1%；n=16）的患者在黏膜中没有检测到癌症，其中 9 例在黏膜下层也没有检测到癌症，最终通过内镜活检难以检测到。
近 40%的临床完全缓解但病理不完全缓解的食管鳞状细胞癌患者在无癌黏膜层下隐藏着残留癌。
