Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Surg Today. 2021 Sep;51(9):1496-1505. doi: 10.1007/s00595-021-02277-7. Epub 2021 Apr 2.
Predicting the response to neoadjuvant chemoradiotherapy (NCRT) and the prognosis of esophageal squamous cell carcinoma (ESCC) is challenging. This study evaluated the potential of a preoperative computed tomography (CT) analysis for predicting the pathological response and survival of patients with ESCC who received trimodality therapy.
A total of 119 patients with cT3 or T4 ESCC who underwent surgery following NCRT between 2007 and 2019 were assessed. The CT-based parameters were measured with enhanced CT preoperatively, prior to and during treatment. Associations between these parameters and the pathologic response, as well as the prognosis, were examined.
Pretreatment maximum CT value (p = 0.009), pretreatment mean CT value (p = 0.022), preoperative whole tumor volume (WTV, p = 0.003), preoperative largest cross section (LCS, p = 0.002), ΔLCS (pretreatment to preoperative, p = 0.004), ΔWTV (pretreatment to preoperative, p = 0.012), and Δmean CT value (pretreatment to preoperative, p = 0.012) of the primary lesion were significantly associated with a good pathological response. A Cox-regression analysis of recurrence-free survival (RFS) and overall survival (OS) showed that preoperative LCS was an independent CT-based predictor. RFS and OS were significantly higher at the optimal cut-off value of the preoperative LCS (p = 0.036 and p = 0.016, respectively).
CT-based parameters are thus considered to be valuable predictors of the tumor response and survival after trimodality therapy for ESCC.
预测新辅助放化疗（NCRT）的反应和食管鳞癌（ESCC）的预后具有挑战性。本研究评估了术前计算机断层扫描（CT）分析对接受三联疗法的 ESCC 患者的病理反应和生存的预测潜力。
共评估了 119 例 2007 年至 2019 年接受 NCRT 后手术的 cT3 或 T4 ESCC 患者。术前、治疗前和治疗期间对基于 CT 的参数进行了增强 CT 测量。检查这些参数与病理反应以及预后之间的相关性。
治疗前最大 CT 值（p=0.009）、治疗前平均 CT 值（p=0.022）、术前全肿瘤体积（WTV，p=0.003）、术前最大横截面积（LCS，p=0.002）、ΔLCS（治疗前到术前，p=0.004）、ΔWTV（治疗前到术前，p=0.012）和原发性病变的平均 CT 值（治疗前到术前，p=0.012）与良好的病理反应显著相关。对无复发生存（RFS）和总生存（OS）的 Cox 回归分析显示，术前 LCS 是独立的基于 CT 的预测因素。术前 LCS 的最佳截断值时，RFS 和 OS 显著更高（p=0.036 和 p=0.016）。
因此，CT 基于参数被认为是 ESCC 接受三联疗法后肿瘤反应和生存的有价值的预测指标。
