Chao Yin-Kai, Wen Yu-Wen, Chang Hsien-Kun, Tseng Chen-Kan, Liu Yun-Hen
Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan.
Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan; Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
Eur J Surg Oncol. 2017 Dec;43(12):2366-2373. doi: 10.1016/j.ejso.2017.09.022. Epub 2017 Oct 16.
The accuracy of endoscopic esophageal biopsy after neoadjuvant chemoradiotherapy (nCRT) remains suboptimal. We retrospectively examined the factors that may affect the diagnostic accuracy of post-nCRT endoscopic biopsy in patients with esophageal squamous cell carcinoma (ESCC).
A total of 213 ESCC patients were enrolled. Biopsy findings were cross-checked against the final pathology outcomes (ypT0 versus non-ypT0) to assess their accuracy. The independent predictors of diagnostic accuracy were identified by multivariate logistic regression analysis.
Post-nCRT endoscopic biopsy results were diagnostically consistent with the final pathology outcomes in 116 (54.5%) patients. Multivariate logistic regression analysis identified a long time interval between the completion of nCRT and the endoscopic examination as the only factor independently associated with a higher diagnostic accuracy. Receiver operating characteristic curve analysis showed that the optimal cutoff value for the time interval between nCRT completion and endoscopic biopsy was 45 days. The estimated diagnostic accuracies of biopsies performed before and after the optimal cutoff time were 49.1% and 72.9%, respectively.
Endoscopic biopsies performed ≥45 days after nCRT are associated with a higher diagnostic accuracy. This time cutoff may serve as a reference to inform the choice of the optimal treatment strategy following nCRT, especially among complete responders in whom surgery withholding is being considered.
新辅助放化疗（nCRT）后内镜下食管活检的准确性仍不尽人意。我们回顾性研究了可能影响食管鳞状细胞癌（ESCC）患者nCRT后内镜活检诊断准确性的因素。
共纳入213例ESCC患者。将活检结果与最终病理结果（ypT0与非ypT0）进行交叉核对，以评估其准确性。通过多因素逻辑回归分析确定诊断准确性的独立预测因素。
nCRT后内镜活检结果与116例（54.5%）患者的最终病理结果在诊断上一致。多因素逻辑回归分析确定，nCRT结束至内镜检查之间的时间间隔较长是与较高诊断准确性独立相关的唯一因素。受试者工作特征曲线分析显示，nCRT结束至内镜活检之间时间间隔的最佳截断值为45天。在最佳截断时间之前和之后进行活检的估计诊断准确性分别为49.1%和72.9%。
nCRT后≥45天进行的内镜活检具有较高的诊断准确性。这个时间截断值可作为参考，为nCRT后最佳治疗策略的选择提供依据，尤其是在考虑暂不进行手术的完全缓解者中。
