Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA.
Department of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC.
Ann Surg. 2023 Oct 1;278(4):e754-e759. doi: 10.1097/SLA.0000000000005837. Epub 2023 Mar 13.
To evaluate the adoption and clinical impact of endoscopic resection (ER) in early esophageal cancer.
Staging for early esophageal cancer is largely inaccurate. Assessment of the impact of ER on staging accuracy is unknown, as is the implementation of ER.
We retrospectively reviewed 2608 patients captured in the Society of Thoracic Surgeons General Thoracic Surgery Database between 2015 and 2020. Patients with clinical T1 and T2 esophageal cancer without nodal involvement (N0) who were treated with upfront esophagectomy were included. Staging accuracy was assessed by clinical-pathologic concordance among patients staged with and without ER. We also sought to measure adherence to National Comprehensive Cancer Network staging guidelines for esophageal cancer staging, specifically the implementation of ER.
For early esophageal cancer, computed tomography/positron emission tomography/endoscopic ultrasound (CT/PET/EUS) accurately predicts the pathologic tumor (T) stage 58.5% of the time. The addition of ER to staging was related to a decrease in upstaging from 17.6% to 10.8% ( P =0.01). Adherence to staging guidelines with CT/PET/EUS improved from 58.2% between 2012 and 2014 to 77.9% between 2015 and 2020. However, when ER was added as a staging criterion, adherence decreased to 23.3%. Increased volume of esophagectomies within an institution was associated with increased staging adherence with ER ( P =0.008).
The use of CT/PET/EUS for the staging of early esophageal cancer is accurate in only 56.3% of patients. ER may increase staging accuracy as it is related to a decrease in upstaging. ER is poorly utilized in staging of early esophageal cancer. Barriers to the implementation of ER as a staging modality should be identified and corrected.
评估内镜下切除术（ER）在早期食管癌中的应用及临床影响。
早期食管癌的分期大多不准确。ER 对分期准确性的影响评估以及 ER 的实施情况均未知。
我们回顾性分析了 2015 年至 2020 年期间收录于胸外科医师学会胸外科数据库中的 2608 例患者。纳入的患者为未经淋巴结受累（N0）的临床 T1 和 T2 食管癌症患者，接受了初始食管切除术治疗。通过对接受和未接受 ER 治疗的患者进行临床病理一致性评估，评估分期准确性。我们还试图衡量国家综合癌症网络（NCCN）食管癌分期指南的实施情况，特别是 ER 的实施情况。
对于早期食管癌，计算机断层扫描/正电子发射断层扫描/内镜超声（CT/PET/EUS）准确预测病理肿瘤（T）分期的准确率为 58.5%。增加 ER 进行分期与分期升级率从 17.6%下降至 10.8%（P=0.01）有关。2012 年至 2014 年，CT/PET/EUS 遵循分期指南的比例为 58.2%，而 2015 年至 2020 年则提高至 77.9%。然而，当 ER 作为分期标准时，遵循率则下降至 23.3%。机构内食管切除术数量的增加与 ER 分期的增加相关（P=0.008）。
CT/PET/EUS 用于早期食管癌分期的准确率仅为 56.3%。ER 可能会提高分期准确性，因为它与分期升级率的降低有关。ER 在早期食管癌的分期中使用不足。应确定并纠正 ER 作为分期手段的实施障碍。
