Taghizadeh Kermani Ali, Ghanbarzadeh Raha, Joudi Mashhad Mona, Javadinia Seyed Alireza, Emadi Torghabeh Ali
Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
Front Oncol. 2022 May 11;12:859079. doi: 10.3389/fonc.2022.859079. eCollection 2022.
No standard method has been defined to evaluate the therapeutic response of esophageal cancer to neoadjuvant chemoradiotherapy (CRT). This study aimed to determine the predictive value of endoscopic evaluation and biopsy after CRT in predicting the complete pathological response to neoadjuvant CRT in patients with esophageal squamous cell carcinoma (SCC).
This prospective, descriptive study was conducted on patients with stage II and III esophageal SCC who could undergo esophagectomy. Patients underwent neoadjuvant CRT. Four to six weeks after the end of treatment, re-endoscopy was performed and a biopsy was taken in the presence of a tumor lesion. In the absence of a tumor lesion, the marked site of the esophagus was removed as a blind biopsy. Gastrologist observations during endoscopy and the result of the pathological examination of an endoscopic biopsy were recorded. The patient underwent esophagectomy. The pathology obtained from endoscopic biopsy was compared with the pathology response obtained from esophagectomy.
Sixty-nine patients were included in the study, of which 32 underwent esophagectomy. In an endoscopic examination after CRT, 28 patients had macroscopic tumor remnants and 4 patients did not. Pathological examination of the samples obtained from endoscopy showed no tumor remnants in 10 patients (31.3%), and in 22 patients (68.7%), living tumor remnants were seen in the biopsy specimen. Pathologic evaluation of the samples obtained by surgical resection showed that in 13 patients, there were no viable carcinomas in the esophagus or lymph nodes removed, and the rate of pathologic complete response was 40.6. Sensitivity, specificity, positive predictive, and negative predictive values of endoscopic observations were 94.7, 23, 64.2, and 75%, respectively. Preoperative biopsy sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 68.4, 30.7, 59, and 40%, respectively.
Considering the negative and positive predictive values of endoscopic observations and biopsy after neoadjuvant CRT, it seems that these two methods alone are not suitable for assessing the pathologic complete response after neoadjuvant treatment.
目前尚未定义评估食管癌新辅助放化疗（CRT）治疗反应的标准方法。本研究旨在确定CRT后内镜评估和活检在预测食管鳞状细胞癌（SCC）患者对新辅助CRT的完全病理反应方面的预测价值。
本前瞻性描述性研究针对可接受食管切除术的II期和III期食管SCC患者进行。患者接受新辅助CRT。治疗结束后4至6周，进行再次内镜检查，并在存在肿瘤病变时取活检。若不存在肿瘤病变，则切除食管标记部位作为盲检。记录胃肠病学家在内镜检查时的观察结果以及内镜活检的病理检查结果。患者接受食管切除术。将内镜活检获得的病理结果与食管切除术获得的病理反应进行比较。
69例患者纳入研究，其中32例接受了食管切除术。CRT后的内镜检查中，28例患者有肉眼可见的肿瘤残留，4例患者无残留。内镜检查样本的病理检查显示，10例患者（31.3%）无肿瘤残留，22例患者（68.7%）的活检标本中可见存活的肿瘤残留。手术切除样本的病理评估显示，13例患者切除的食管或淋巴结中无存活癌，病理完全缓解率为40.6%。内镜观察的敏感性、特异性、阳性预测值和阴性预测值分别为94.7%、23%、64.2%和75%。术前活检的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为68.4%、30.7%、59%和40%。
考虑到新辅助CRT后内镜观察和活检的阴性和阳性预测值，似乎仅这两种方法不适合评估新辅助治疗后的病理完全缓解情况。
