Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Surgery, Osaka General Medical Center, Osaka, Japan.
Ann Surg. 2020 May;271(5):875-884. doi: 10.1097/SLA.0000000000003129.
To investigate the residual pattern of esophageal cancer in the esophageal wall after neoadjuvant chemotherapy (NAC) and its clinical significance.
NAC is a standard treatment for locally advanced esophageal cancer; however, residual tumor patterns in resected specimens after NAC and their clinico-pathological characteristics remain unknown.
One hundred twenty consecutive patients with cT3 or deeper esophageal cancer underwent curative esophagectomy after NAC and achieved grade 2 histological responses between 2000 and 2016. Hematoxylin-eosin staining of residual tumor sections revealed 4 remnant categories: Type 1: shallow, Type 2: central, Type 3: deep, and Type 4: diffuse. We examined associations between these Types and clinico-pathological factors, including prognosis.
Forty-five (38%) specimens had no residual tumor cells in the mucosal layer. The adventitia layer displayed the lowest residual tumor cell frequency (18%) among all layers. Types 1, 2, 3, and 4 residual tumor patterns were found in 49 (41%), 33 (28%), 9 (8%), and 29 (24%) patients, respectively. Type 4 showed the maximum standard uptake value after NAC; Types 3 and 4 had higher ratios of venous invasion than Type 1 or 2. Patients with Type 3 or 4 more frequently developed pleural dissemination or distant metastasis than patients with Type 1 or 2. Survival was similar among the 4 Types.
After NAC for locally advanced esophageal cancer, the shallow residual tumor pattern was most common, but approximately 40% of specimens showed no tumor cells in the mucosal layer. Deep and diffuse remnant patterns were associated with high risks of pleural dissemination and distant metastasis.
探讨新辅助化疗（NAC）后食管癌在食管壁中的残留模式及其临床意义。
NAC 是局部晚期食管癌的标准治疗方法；然而，NAC 后切除标本中的残留肿瘤模式及其临床病理特征仍不清楚。
2000 年至 2016 年间，120 例接受 NAC 治疗的 cT3 或更深的食管癌患者接受了根治性食管切除术，并获得了 2 级组织学反应。残留肿瘤切片的苏木精-伊红染色显示 4 种残留类型：1 型：浅，2 型：中央，3 型：深，4 型：弥漫。我们检查了这些类型与包括预后在内的临床病理因素之间的关联。
45 份（38%）标本的黏膜层无残留肿瘤细胞。所有层中，外膜层的残留肿瘤细胞频率最低（18%）。1 型、2 型、3 型和 4 型残留肿瘤模式分别在 49 例（41%）、33 例（28%）、9 例（8%）和 29 例（24%）患者中发现。NAC 后 4 型的标准摄取值最大；3 型和 4 型的静脉侵犯比例高于 1 型或 2 型。3 型或 4 型患者比 1 型或 2 型患者更频繁地发生胸膜播散或远处转移。4 种类型的生存情况相似。
局部晚期食管癌 NAC 后，浅残留肿瘤模式最常见，但约 40%的标本黏膜层无肿瘤细胞。深和弥漫性残留模式与胸膜播散和远处转移的高风险相关。
