食管癌新辅助放化疗后局部再生长与主动监测：来自SANO试验手术标本的分析
Local Regrowth After Neoadjuvant Chemoradiotherapy and Active Surveillance for Esophageal Cancer: An Analysis of Surgical Specimens From the SANO Trial.
作者
作者单位
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
- Department of Pathology, LabPON, Almelo, the Netherlands.
- Department of Pathology, Gelre Hospital, Apeldoorn, the Netherlands.
- Department of Pathology, Maasstad Hospital, Rotterdam, the Netherlands.
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Pathology, PAMM, Eindhoven, the Netherlands.
- Department of Pathology, Pathology Friesland, Leeuwarden, the Netherlands.
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department of Pathology, Zuyderland Medical Center, Heerlen, the Netherlands.
- Department of Pathology, Reinier de Graaf Gasthuis, Delft, the Netherlands.
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
摘要
中文
旨在评估食管癌新辅助放化疗（nCRT）后再生长的模式。这可能有助于优化疗效评估，并探索内镜下治疗癌症再生长的可能性。主动监测是局部晚期食管癌患者的一种治疗方法，但及时检测再生长仍具挑战性。对nCRT后3个月达到完全临床缓解并接受主动监测的患者进行了一项回顾性队列研究。纳入接受手术的癌症再生长患者。由2名病理学家审查切除标本。主要结局是食管壁内再生长的解剖层。共获得nCRT后6-36个月的75例切除标本。75例中68例（91%）患者黏膜层可见癌细胞。4/75（5%）患者肿瘤局限于黏膜。13/75（17%）患者肿瘤见于黏膜和黏膜下层，但4例患者也有淋巴结受累。总体上，88%的标本中肿瘤存在于黏膜下层，71%在固有肌层，61%在周围间质。大多数再生长发生在全层，且这种模式随时间没有改变。nCRT后检测到的再生长在大多数患者中主要累及黏膜和黏膜下层，其时间性再生长模式支持内镜作为诊断工具。鉴于未检测到淋巴结疾病的风险以及nCRT后分期目前的局限性，手术仍是再生长推荐的治疗方法。
English
To assess pattern of regrowth after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. This may inform optimization of response evaluations and explore the possibility for endoscopic treatment of cancer regrowth. Active surveillance is a treatment approach for patients with locally advanced esophageal cancer but the timely detection of regrowth remains challenging. A retrospective cohort study was conducted in patients with complete clinical response 3 months after nCRT who underwent active surveillance. Patients with cancer regrowth that underwent surgery were included. Resection specimens were reviewed by 2 pathologists. The primary outcome was the anatomic layer(s) of regrowth within the esophageal wall. In total, 75 resection specimens were available 6-36 months after nCRT. Cancer cells were seen in the mucosal layer in 68 of 75 (91%) patients. In 4/75 (5%) patients the tumor was confined to the mucosa. In 13/75 patients (17%), tumor was seen in the mucosa and submucosa but 4 patients also had lymph node involvement. Overall, tumor was present in the submucosa in 88%, proper muscle layer in 71%, and surrounding stroma in 61% of specimens. The majority of regrowth occurred in all layers and this pattern did not change over time. Detected regrowth after nCRT predominantly involves the mucosa and submucosa in the majority of patients and its temporal regrowth pattern support endoscopy as a diagnostic tool. Given the risk of undetected nodal disease and the current limitations of staging after nCRT, surgery remains the recommended treatment for regrowth.
分类与指标
- 研究类型
- 临床研究
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 7.4
- 新锐分区
- 1区