Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou, China.
Thorac Cancer. 2022 Dec;13(23):3304-3309. doi: 10.1111/1759-7714.14686. Epub 2022 Oct 13.
This study aimed to investigate the value and efficiency of routine brain MRI or CT in the preoperative workup for patients with potentially resectable (cT N ) thoracic esophageal squamous cell cancer (ESCC).
This was a prospective cross-sectional clinical trial (ChiCTR1800020304). A total of 385 patients with potentially resectable (cT N ) thoracic ESCC diagnosed from October 2018 to August 2020 were included. Plain brain MRI or CT was performed preoperatively to detect brain metastases (BrM). The primary endpoint was BrM detected by imaging.
Of all 385 patients, the rate of positive brain MRI/CT findings was 1% (n = 4). BrM Patients received chemoradiotherapy, and the median OS was 6 months (95% CI: 4.303-7.697). All 381 remaining patients with initial negative brain MRI/CT diagnosis revealed no brain-associated symptoms within 6 months. The median follow-up for patients without BrM was 20 months (range, from 6 to 32). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of plain MRI or CT to detect BrM were all 100%.
Preoperative plain MRI or CT is an effective method to detect BrM for potentially resectable (cT N ) thoracic ESCC. However, due to the low incidence, the value of brain MRI/CT as a routinely preoperational examination in potentially resectable esophageal squamous cell cancer is rather limited. Therefore, preoperative brain MRI/CT should not be recommended as a routine preoperative examination for ESCC.
本研究旨在探讨在可切除（cT N ）胸段食管鳞癌（ESCC）患者的术前检查中，常规脑 MRI 或 CT 的价值和效率。
这是一项前瞻性的横断面临床试验（ChiCTR1800020304）。共纳入 2018 年 10 月至 2020 年 8 月期间诊断为可切除（cT N ）胸段 ESCC 的 385 例患者。所有患者均行术前颅脑 MRI 或 CT 平扫，以检测脑转移瘤（BrM）。主要终点是影像学检查发现的 BrM。
385 例患者中，脑 MRI/CT 阳性率为 1%（n=4）。有 BrM 的患者接受了放化疗，中位总生存期（OS）为 6 个月（95%CI：4.303-7.697）。所有 381 例初始脑 MRI/CT 诊断为阴性的患者在 6 个月内均未出现脑相关症状。无 BrM 的患者中位随访时间为 20 个月（范围为 6 至 32 个月）。MRI 或 CT 平扫检测 BrM 的灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）均为 100%。
术前颅脑 MRI 或 CT 是一种有效检测可切除（cT N ）胸段 ESCC 脑转移瘤的方法。然而，由于发病率较低，脑 MRI/CT 作为潜在可切除食管鳞癌常规术前检查的价值相当有限。因此，不建议将术前脑 MRI/CT 作为 ESCC 的常规术前检查。
