Gambella Alessandro, Fiocca Roberto, Lugaresi Marialuisa, D'Errico Antonietta, Malvi Deborah, Spaggiari Paola, Tomezzoli Anna, Albarello Luca, Ristimäki Ari, Bottiglieri Luca, Bonora Elena, Krishnadath Kausilia K, Raulli Gian Domenico, Rosati Riccardo, Romario Uberto Fumagalli, De Manzoni Giovanni, Räsänen Jari, Mattioli Sandro, Grillo Federica, Mastracci Luca
Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy.
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy.
Cancers (Basel). 2024 Dec 2;16(23):4045. doi: 10.3390/cancers16234045.
The Esophageal Adenocarcinoma Study Group Europe (EACSGE) recently proposed a granular histologic classification of esophageal-esophago-gastric junctional adenocarcinomas (EA-EGJAs) based on the study of naïve surgically resected specimens that, when combined with the pTNM stage, is an efficient indicator of prognosis, molecular events, and response to treatment. In this study, we compared histologic classes of endoscopic biopsies taken before surgical resection with those of the surgical specimen, to evaluate the potential of the EACSGE classification at the initial diagnostic workup. A total of 106 EA-EGJA cases with available endoscopic biopsies and matched surgical resection specimens were retrieved from five Italian institutions. Histologic classification was performed on all specimens to identify well-differentiated glandular adenocarcinoma (WD-GAC), poorly differentiated glandular adenocarcinoma (PD-GAC), mucinous muconodular carcinoma (MMC), infiltrative mucinous carcinoma (IMC), diffuse desmoplastic carcinoma, diffuse anaplastic carcinoma (DAC), and mixed subtypes. Related risk subgroups (low-risk versus high-risk) were also assessed. The correlations of histologic classes and risk subgroups between diagnostic biopsies and surgical resection specimens were explored with Spearman's correlation test. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, true positives, true negatives, false positives, and false negatives were also calculated. A strong positive correlation between biopsies and surgical specimens occurred for both histologic classes (coefficient: 0.75, < 0.001) and risk subgroups (coefficient: 0.65, < 0.001). The highest sensitivities and specificities were observed for MMC, IMC, and DAC (100% and 99% for all), followed by WD-GAC (sensitivity 91%, specificity 79%) and PD-GAC (sensitivity 722%, specificity 86%). The low-risk and high-risk groups presented a sensitivity and specificity of 89% and 76% (low-risk) and 76% and 89% (high-risk). The EACSGE histologic classification of EA-EGJAs and associated prognostic subgroups can be reliably assessed on pre-operative diagnostic biopsies. Further studies on larger and more representative cohorts of EA-EGJAs will allow us to validate our findings and confirm if the EA-EGJA biopsy histomorphology and clinical TNM staging will be as efficient as the surgical specimen histomorphology and pTNM in predicting patient prognoses and tailoring personalized therapeutic approaches.
欧洲食管腺癌研究组（EACSGE）最近基于对未经处理的手术切除标本的研究，提出了食管-食管胃交界腺癌（EA-EGJAs）的颗粒状组织学分类，该分类与pTNM分期相结合，是预后、分子事件及治疗反应的有效指标。在本研究中，我们比较了手术切除前获取的内镜活检组织学类别与手术标本的组织学类别，以评估EACSGE分类在初始诊断检查中的潜力。从五家意大利机构检索到106例有可用内镜活检及匹配手术切除标本的EA-EGJA病例。对所有标本进行组织学分类，以识别高分化腺腺癌（WD-GAC）、低分化腺腺癌（PD-GAC）、黏液性黏液结节癌（MMC）、浸润性黏液癌（IMC）、弥漫性促纤维组织增生性癌、弥漫性间变性癌（DAC）及混合亚型。还评估了相关风险亚组（低风险与高风险）。采用Spearman相关性检验探索诊断活检与手术切除标本之间组织学类别及风险亚组的相关性。还计算了敏感性、特异性、准确性、阳性预测值、阴性预测值、真阳性、真阴性、假阳性及假阴性。活检与手术标本在组织学类别（系数：0.75，<0.001）及风险亚组（系数：0.65，<0.001）方面均存在强正相关。MMC、IMC和DAC的敏感性和特异性最高（均为100%和99%），其次是WD-GAC（敏感性91%，特异性79%）和PD-GAC（敏感性722%，特异性86%）。低风险和高风险组的敏感性和特异性分别为89%和76%（低风险）以及76%和89%（高风险）。EA-EGJAs的EACSGE组织学分类及相关预后亚组可通过术前诊断活检可靠评估。对更大且更具代表性的EA-EGJA队列进行进一步研究，将使我们能够验证我们的发现，并确认EA-EGJA活检组织形态学和临床TNM分期在预测患者预后及制定个性化治疗方案方面是否与手术标本组织形态学和pTNM一样有效。
