A.C. Camargo Cancer Center, Endoscopy Unit, São Paulo, SP, Brazil.
A.C. Camargo Cancer Center, Gastrointestinal Surgical Oncology Unit, São Paulo, SP, Brazil.
Arq Bras Cir Dig. 2022 Jan 5;34(3):e1616. doi: 10.1590/0102-672020210002e1616. eCollection 2022.
Gastric and esophagogastric junction adenocarcinoma are responsible for approximately 13.5% of cancer-related deaths. Given the fact that these tumors are not typically detected until they are already in the advanced stages, neoadjuvancy plays a fundamental role in improving long-term survival. Identification of those with complete pathological response (pCR) after neoadjuvant chemotherapy (NAC) is a major challenge, with effects on organ preservation, extent of resection, and additional surgery. There is little or no information in the literature about which endoscopic signs should be evaluated after NAC, or even when such re-evaluation should occur.
To describe the endoscopic aspects of patients with gastric and esophagogastric junction adenocarcinomas who underwent NAC and achieved pCR, and to determine the accuracy of esophagogastroduodenoscopy (EGD) in predicting the pCR.
A survey was conducted of the medical records of patients with these tumors who were submitted to gastrectomy after NAC, with anatomopathological result of pCR.
Twenty-nine patients were identified who achieved pCR after NAC within the study period. Endoscopic responses were used to classify patients into two groups: G1-endoscopic findings consistent with pCR and G2-endoscopic findings not consistent with pCR. Endoscopic evaluation in G1 was present in an equal percentage (47.4%; p=0.28) in Borrmann classification II and III. In this group, the predominance was in the gastric body (57.9%; p=0.14), intestinal subtype with 42.1% (p=0.75), undifferentiated degree, 62.5% (p=0.78), Herb+ in 73.3% (p=0.68). The most significant finding, however, was that the time interval between NAC and EGD was longer for G1 than G2 (24.4 vs. 10.2 days, p=0.008).
EGD after NAC seems to be a useful tool for predicting pCR, and it may be possible to use it to create a reliable response classification. In addition, the time interval between NAC and EGD appears to significantly influence the predictive power of endoscopy for pCR.
胃和食管胃结合部腺癌约占癌症相关死亡人数的 13.5%。由于这些肿瘤通常在晚期才被发现，因此新辅助治疗在提高长期生存率方面起着至关重要的作用。新辅助化疗（NAC）后完全病理缓解（pCR）的识别是一个主要挑战，这对器官保存、切除范围和进一步手术有影响。关于 NAC 后应评估哪些内镜征象，甚至何时进行再次评估，文献中几乎没有或没有信息。
描述接受 NAC 且达到 pCR 的胃和食管胃结合部腺癌患者的内镜表现，并确定食管胃十二指肠镜（EGD）预测 pCR 的准确性。
对接受 NAC 后行胃切除术且具有 pCR 解剖病理学结果的这些肿瘤患者的病历进行了调查。
在研究期间，确定了 29 例 NAC 后达到 pCR 的患者。内镜反应用于将患者分为两组：G1-内镜表现与 pCR 一致和 G2-内镜表现与 pCR 不一致。G1 中的内镜评估在 Borrmann 分类 II 和 III 中出现的比例相等（47.4%；p=0.28）。在该组中，胃体的优势更为明显（57.9%；p=0.14），肠型占 42.1%（p=0.75），未分化程度占 62.5%（p=0.78），Herb+占 73.3%（p=0.68）。然而，最重要的发现是，G1 与 G2 之间的 NAC 与 EGD 之间的时间间隔较长（24.4 与 10.2 天，p=0.008）。
NAC 后 EGD 似乎是预测 pCR 的有用工具，并且可能可以使用它来创建可靠的反应分类。此外，NAC 与 EGD 之间的时间间隔似乎会显著影响内镜预测 pCR 的能力。
