Chen Xue, Chen Xi, Bao Yu, Zhang Wei, Jiang Li, Zhu Jie, Wang Yi, Wu Lei, Wan Gang, Peng Lin, Han Yongtao, Leng Xuefeng, Wang Qifeng, Zhao Rui
School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China.
Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China.
Endosc Ultrasound. 2023 Jul-Aug;12(4):369-376. doi: 10.1097/eus.0000000000000008. Epub 2023 Sep 13.
EUS-derived maximum tumor thickness (MTT) pre- and post-neoadjuvant chemoradiotherapy (NCRT) for locally advanced esophageal squamous cell carcinoma (LA-ESCC) indicates treatment response. However, the accuracy of predicting long-term survival remains uncertain. This study aimed to investigate the association between EUS-derived MTT pre- and post-NCRT and tumor shrinkage rate as well as long-term survival in patients with LA-ESCC receiving NCRT.
We retrospectively enrolled patients with LA-ESCC who underwent EUS examination from 2017 to 2021. Tumor shrinkage rate was the ratio of the difference between pre- and post-MTT to pre-MTT. The most fitted cutoff values were determined by the receiver operating characteristic curve. Univariate and multivariate Cox regression analyses and Kaplan-Meier curves were used to calculate overall survival (OS) and progression-free survival. Data from another center were also used for external validation testing.
Two hundred thirty patients were enrolled. Of the patients, 178 completed the first EUS pre-NCRT and obtained pre-MTT, 200 completed the reexamined EUS post-NCRT and obtained post-MTT, and 148 completed both EUS and achieved tumor shrinkage. For all the patients, the 1- and 3-year OS rates were 93.9% and 67.9%, and progression-free survival rates were 77.7% and 54.1%, respectively. The median follow-up period was 30.6 months. Thinner post-MTT (≤8.8 mm) and EUS responder (tumor shrinkage rate ≥52%) were independently associated with better OS.
EUS-derived MTT and tumor shrinkage post-NCRT are independent prognostic factors for long-term survival and may be an alternative method for evaluating tumor response in patients with LA-ESCC after NCRT.
对于局部晚期食管鳞状细胞癌（LA-ESCC），新辅助放化疗（NCRT）前后基于超声内镜（EUS）得出的最大肿瘤厚度（MTT）可表明治疗反应。然而，预测长期生存的准确性仍不确定。本研究旨在探讨LA-ESCC患者接受NCRT时，NCRT前后基于EUS得出的MTT与肿瘤缩小率以及长期生存之间的关联。
我们回顾性纳入了2017年至2021年接受EUS检查的LA-ESCC患者。肿瘤缩小率为MTT前后差值与MTT前值的比值。通过受试者工作特征曲线确定最适宜的截断值。采用单因素和多因素Cox回归分析以及Kaplan-Meier曲线来计算总生存期（OS）和无进展生存期。另一个中心的数据也用于外部验证测试。
共纳入230例患者。其中，178例患者在NCRT前完成了首次EUS检查并获得MTT前值，200例患者在NCRT后完成了复查EUS并获得MTT后值，148例患者同时完成了两次EUS检查并实现了肿瘤缩小。所有患者的1年和3年OS率分别为93.9%和67.9%，无进展生存率分别为77.7%和54.1%。中位随访期为30.6个月。MTT后值较薄（≤8.8 mm）和EUS反应者（肿瘤缩小率≥52%）与更好的OS独立相关。
NCRT后基于EUS得出的MTT和肿瘤缩小是长期生存的独立预后因素，可能是评估LA-ESCC患者NCRT后肿瘤反应的一种替代方法。
