内镜超声在预测食管鳞状细胞癌放化疗后局部失败的挽救性内镜治疗疗效中的应用价值

Usefulness of endoscopic ultrasound in predicting treatment efficacy of salvage endoscopic therapy for local failure after chemoradiotherapy for esophageal squamous cell carcinoma.

作者信息

Mitsui Tomohiro, Nakajo Keiichiro, Takashima Kenji, Murano Tatsuro, Kadota Tomohiro, Shinmura Kensuke, Yoda Yusuke, Ikematsu Hiroaki, Maeda Shin, Yano Tomonori

机构信息

Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.

Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.

出版信息

Esophagus. 2023 Jan;20(1):116-123. doi: 10.1007/s10388-022-00954-1. Epub 2022 Oct 19.

DOI:10.1007/s10388-022-00954-1

PMID:36260171

Abstract

BACKGROUND

Salvage endoscopic therapy, including endoscopic resection (ER) and photodynamic therapy (PDT), is effective for esophageal squamous cell carcinoma (ESCC) in local failure after chemoradiotherapy (CRT). Resection with pathologically vertical margin-negative (VM0) for ER and local complete response (L-CR) for PDT are important surrogate prognostic markers for each therapy's efficacy. We aimed to evaluate the usefulness of endoscopic ultrasound (EUS) in predicting the efficacy of salvage endoscopic therapy in local failure after CRT for ESCC.

METHODS

We included patients who underwent EUS followed by ER or PDT for local failure after CRT or radiotherapy for ESCC from 2006 to 2020. We evaluated EUS findings associated with VM0 resection for ER and L-CR for PDT, which included the status of the outermost part of the submucosal layer, tumor thickness, and tumor invasion length into the muscularis propria (MP) layer.

RESULTS

Thirty and 47 patients were enrolled into the ER and PDT groups, respectively. The VM0 resection rate in the ER group was 87% (26/30). The EUS findings associated with VM0 resection were tumor thickness < 2.3 mm (p = 0.01) and preserved hyperechoic line of the outermost part of the submucosa layer (p < 0.01). The L-CR rate in the PDT group was 69% (32/47). The EUS findings associated with L-CR were tumor thickness < 5.0 mm (p < 0.01) and tumor invasion length into the MP layer < 1.6 mm (p = 0.03).

CONCLUSIONS

EUS can be useful in predicting the efficacy of salvage endoscopic treatment for local failure after CRT for ESCC.

摘要

背景

挽救性内镜治疗，包括内镜切除术（ER）和光动力疗法（PDT），对于放化疗（CRT）后局部复发的食管鳞状细胞癌（ESCC）有效。ER实现病理垂直切缘阴性（VM0）切除以及PDT达到局部完全缓解（L-CR）是每种治疗疗效的重要替代预后标志物。我们旨在评估内镜超声（EUS）在预测CRT后局部复发的ESCC挽救性内镜治疗疗效方面的实用性。

方法

我们纳入了2006年至2020年期间因ESCC接受CRT或放疗后局部复发而接受EUS检查，随后进行ER或PDT的患者。我们评估了与ER的VM0切除和PDT的L-CR相关的EUS表现，包括黏膜下层最外层的状态、肿瘤厚度以及肿瘤侵犯固有肌层（MP）的长度。

结果

ER组和PDT组分别纳入了30例和47例患者。ER组的VM0切除率为87%（26/30）。与VM0切除相关的EUS表现为肿瘤厚度<2.3 mm（p = 0.01）和黏膜下层最外层高回声线完整（p < 0.01）。PDT组的L-CR率为69%（32/47）。与L-CR相关的EUS表现为肿瘤厚度<5.0 mm（p < 0.01）和肿瘤侵犯MP层的长度<1.6 mm（p = 0.03）。