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胃癌超声内镜分期:它是否有助于新辅助治疗时期的管理决策?

发布日期:2014-1-29 12:40:42 文章来源:ENDOSCOPY 作者次数:1234
     胃癌超声内镜分期:它是否有助于新辅助治疗时期的管理决策?

    A. Kutup1, Y. K. Vashist1, S. Groth2, E. Vettorazzi3, E. F. Yekebas1, N. Soehendra2, J. R. Izbicki1

    1德国汉堡市汉堡-埃彭多夫大学医学中心普外科和内脏科以及胸外科。

    2德国汉堡市汉堡-埃彭多夫大学医学中心跨学科内镜科。

    3德国汉堡市汉堡-埃彭多夫大学医学中心医学生物统计学和流行病学科。

    背景与研究目的:一直以来我们认为内镜超声检查(EUS)是最准确的上消化道肿瘤局部分期的检测方法;然而,近来,有些研究开始质疑它在日常临床应用中的准确性等级。本回顾性研究分析了内镜超声检查术在指导多学科治疗决策中的准确性。

    患者与方法:本研究共包括123例主要手术患者,其中,63%男性患者,平均年龄为61.4岁;我们仅选择了那些无瘤切缘且未见远端转移的患者。然后我们对超声内镜检查和组织病理性检查结果进行比较。根据假定的治疗分层算法,本研究中我们对主要手术目标肿瘤(T1 /2N0)与采用新辅助或围手术化疗治疗的肿瘤(T3/4,或任何N +)进行了比较,而它们之间的区别即为本研究的主要结果参数。

    结果:不管肿瘤位置在哪,T的超声内镜检查术的总体分期准确度为44.7%,而N 状态的内镜超声检查术的总体分期准确度为71.5 %。主要问题是分期过度,T的过度分期率为44.9%,而N分期的过度分期率为42.9%。对79.7%(准确度)的患者,其总体内镜超声分类是正确的,灵敏度为91.9 %,且特异性为51.4 %;在37例组织病理学分期为T1/2N0的病例中,内镜超声检查术仅对19例进行了正确分类。在诊断晚期肿瘤阶段中超声内镜检查术对分配给新辅助治疗的阳性和阴性预测值分别为81.4%73.1%

    结论:鉴于超声内镜检查术诊断局部晚期胃癌的灵敏度较高,T2 癌的超声内镜检查常导致过度分期。局部(T1 /2N0)与晚期肿瘤(T3/4 或任何N +)之间的超声内镜下分层进而会导致一半病例出现不正确的新辅助治疗分配。


    Endoscopic ultrasound staging in gastric cancer: Does it help management decisions in the era of neoadjuvant treatment?

    A. Kutup1, Y. K. Vashist1, S. Groth2, E. Vettorazzi3, E. F. Yekebas1, N. Soehendra2, J. R. Izbicki1

    1Department of General, Visceral, and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf,Hamburg,Germany

    2Department of Interdisciplinary Endoscopy, University MedicalCenter of Hamburg-Eppendorf,Hamburg,Germany

    3Department of Medical Biometry and Epidemiology, University MedicalCenter of Hamburg-Eppendorf,Hamburg,Germany

    Background and study aims: Endoscopic ultrasonography (EUS) has been shown to be the most accurate test for locoregional staging of upper gastrointestinal tumors; however, recent studies have questioned its accuracy level in daily clinical application. The present retrospective study analyzes the accuracy of EUS in guiding interdisciplinary treatment decisions.

    Patients and methods: 123 primarily operated patients (63 % men, mean age 61.4 years) were included; only cases with tumor-free resection margins and without evidence of distant metastases were selected. EUS and histopathological findings were compared. Main outcome parameter was the distinction between tumors to be primarily operated (T1 /2N0) and those to be treated by neoadjuvant or perioperative chemotherapy (T3/4, or any N + ), based on an assumed algorithm for treatment stratification.

    Results: Overall staging accuracy of EUS was 44.7 % for T and 71.5 % for N status irrespective of tumor location. Overstaging was the main problem (44.9 % for T, 42.9 % for N staging). The overall EUS classification was correct in 79.7 % (accuracy), with a sensitivity 91.9 % and specificity 51.4 %; only 19 out of 37 cases with histopathological T1/2N0 were correctly classified by EUS. Positive and negative predictive values of EUS in diagnosing advanced tumor stage for assignment to neoadjuvant therapy were 81.4 % and 73.1 %, respectively.

    Conclusions: Whereas EUS has a high sensitivity in the diagnosis of locally advanced gastric cancer, endosonographic overstaging of T2 cancers appears to be a frequent problem. EUS stratification between local (T1 /2N0) and advanced (T3/4 or any N + ) tumors would thus result in incorrect assignment to neoadjuvant treatment in half of cases.

     

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