Peninsula Oesophago-gastric Surgery Unit, Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK.
Peninsula Oesophago-gastric Surgery Unit, Derriford Hospital, Derriford Road, Plymouth, Devon, PL6 8DH, UK.
Eur J Radiol. 2017 Dec;97:71-75. doi: 10.1016/j.ejrad.2017.10.015. Epub 2017 Oct 23.
Accuracy of locoregional staging in patients with oesophageal cancer is critical in determining operability and the need for neoadjuvant treatment. Imaging technology has advanced significantly in recent years but it is not known whether this translates to improved staging accuracy. This study investigates staging accuracy in relation to CT, EUS, PET-CT and final pre-operative stage. It specifically addresses the accuracy of staging with respect to the threshold for administering neoadjuvant therapies.
Pre-operative staging according to CT, EUS, PET-CT and final pre-operative stage were compared to the postoperative histological staging in 133 patients undergoing potentially curative surgery (without neoadjuvant therapy) for oesophageal cancer between January 2010 and January 2015. T and N stage accuracies were reported separately for each imaging modality. Patients were also divided into two groups depending on whether the final pre-operative stage was below (≤T2, N0, early tumours) or above (≥T3 and/or ≥N1, locally advanced tumours) the threshold for offering neoadjuvant therapy. Accuracy of pre-operative staging was then analysed with respect to identification of patients below/above this threshold. The additional benefit offered by EUS for this purpose was investigated.
T stage accuracies were 72.6%, 76.7% and 79.3% for CT, EUS and final pre-operative stage respectively. N stage accuracies were 75.6%, 77.2%, 74.5% and 78.6% for CT, EUS, PET-CT and final pre-operative stage respectively. Staging accuracy with respect to threshold for neoadjuvant treatment showed 62.0% early tumours were correctly staged and 80.5% advanced tumours were correctly staged. Whether or not patients underwent EUS did not affect the staging accuracy with respect to neoadjuvant treatment threshold.
Staging accuracy with respect to the threshold for treatment with neoadjuvant therapy is poor, leading to potential over/under treatment. Predicting individual response to neoadjuvant therapy would provide a better way to determine which patients should receive this additional treatment.
在确定手术可行性和新辅助治疗的必要性方面，食管癌患者的局部区域分期准确性至关重要。近年来，影像学技术有了显著进步，但尚不清楚这是否转化为分期准确性的提高。本研究调查了与 CT、EUS、PET-CT 和最终术前分期相关的分期准确性。它特别针对新辅助治疗阈值的分期准确性。
2010 年 1 月至 2015 年 1 月期间，对 133 例接受潜在根治性手术（无新辅助治疗）的食管癌患者，比较术前 CT、EUS、PET-CT 和最终术前分期与术后组织学分期。分别报告每种影像学方法的 T 期和 N 期准确性。还根据最终术前分期是否低于（≤T2、N0、早期肿瘤）或高于（≥T3 和/或≥N1、局部晚期肿瘤）新辅助治疗阈值将患者分为两组。然后，根据是否识别出低于/高于该阈值的患者，分析术前分期的准确性。还研究了 EUS 在此目的下提供的额外益处。
CT、EUS 和最终术前分期的 T 期准确性分别为 72.6%、76.7%和 79.3%。CT、EUS、PET-CT 和最终术前分期的 N 期准确性分别为 75.6%、77.2%、74.5%和 78.6%。关于新辅助治疗阈值的分期准确性表明，62.0%的早期肿瘤分期正确，80.5%的晚期肿瘤分期正确。患者是否接受 EUS 检查并不影响新辅助治疗阈值的分期准确性。
关于新辅助治疗阈值的治疗分期准确性较差，导致潜在的过度/治疗不足。预测个体对新辅助治疗的反应将提供一种更好的方法来确定哪些患者应接受这种额外治疗。
