296.临床 T1B-SM2-3N0M0 食管鳞状细胞癌

IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Toshiro Iizuka, Eriko Noma
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Methods Thirty-eight patients diagnosed with T1b-SM2-3 N0M0 between April 2010 and December 2020 were included in the study. Depth diagnosis was determined through endoscopic evaluation utilizing white light, NBI, NBI magnification plus EUS, with lymph node metastasis diagnosis performed via CT imaging. Treatment decisions were made following patient consent, and long-term prognosis was assessed for each treatment modality. Results Initial treatment involved ESD in 14 patients, with an additional 5 patients undergoing additional treatment (ESD + AD) based on histological evaluation (surgery: 1, CRT: 4). Surgery or neoadjuvant chemotherapy (NAC) followed by surgery was performed in 15 patients, with CRT administered in 7. Among the 22 patients who did not receive NAC and whose histologic depth was evaluable, the accuracy rate of depth diagnosis was 64%, primarily attributable to overdiagnosis. 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引用次数: 0

摘要

背景 随着内窥镜技术的进步,对粘膜下浸润性病变进行更安全、更可靠的内窥镜切除已变得可行。对浅表食管癌治疗效果的评估通常以病理诊断的深度为前提;然而,基于术前诊断的研究却很有限。鉴于临床实践中的治疗决策主要以术前诊断为指导,因此以术前评估为基础的研究备受重视。本研究旨在分析 T1b-SM2-3 N0M0 术前诊断的准确性,评估治疗选择和深度诊断的准确性,并根据这些判断评估长期预后。方法 研究纳入了2010年4月至2020年12月期间诊断为T1b-SM2-3 N0M0的38例患者。深度诊断通过利用白光、NBI、NBI 放大镜和 EUS 进行的内窥镜评估确定,淋巴结转移诊断通过 CT 成像进行。在征得患者同意后做出治疗决定,并对每种治疗方式的长期预后进行评估。结果 14 例患者接受了ESD初始治疗,另有 5 例患者根据组织学评估结果接受了额外治疗(ESD + AD)(手术:1 例,CRT:4 例)。15名患者接受了手术或手术后的新辅助化疗(NAC),7名患者接受了CRT治疗。在22例未接受新辅助化疗且组织学深度可评估的患者中,深度诊断的准确率为64%,主要原因是过度诊断。在接受ESD(不包括零星切除)的14名患者中,垂直边缘的阴性率为93%。五年总生存率如下ESD:64.8%;ESD+AD:75%;手术:86.2%;CRT:86.2%:86.2%,CRT:45.7%,在统计学上未发现显著差异。大多数死亡病例(83%)归因于其他疾病或癌症,只有 2 例死亡病例归因于原发疾病。结论 ESD 或手术是大多数病例的首选治疗方式,长期预后相对较好。治疗决定受到合并症和其他因素的影响,可能会影响长期预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
296. CLINICAL T1B-SM2-3N0M0 ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Background With advancements in endoscopic techniques, safer and more reliable endoscopic resection of submucosal invasive lesions has become feasible. The evaluation of treatment outcomes for superficial esophageal carcinoma has typically been predicated on the depth of pathological diagnosis; however, there have been limited studies based on preoperative diagnosis. Given that treatment decisions in clinical practice are primarily guided by preoperative diagnosis, there is a heightened emphasis on studies grounded in preoperative assessments. This study aims to analyze the accuracy of preoperative diagnosis of T1b-SM2-3 N0M0, evaluate the accuracy of treatment selection and depth diagnosis, and assess long-term outcomes based on these determinations. Methods Thirty-eight patients diagnosed with T1b-SM2-3 N0M0 between April 2010 and December 2020 were included in the study. Depth diagnosis was determined through endoscopic evaluation utilizing white light, NBI, NBI magnification plus EUS, with lymph node metastasis diagnosis performed via CT imaging. Treatment decisions were made following patient consent, and long-term prognosis was assessed for each treatment modality. Results Initial treatment involved ESD in 14 patients, with an additional 5 patients undergoing additional treatment (ESD + AD) based on histological evaluation (surgery: 1, CRT: 4). Surgery or neoadjuvant chemotherapy (NAC) followed by surgery was performed in 15 patients, with CRT administered in 7. Among the 22 patients who did not receive NAC and whose histologic depth was evaluable, the accuracy rate of depth diagnosis was 64%, primarily attributable to overdiagnosis. In the 14 patients who underwent ESD excluding piecemeal resection, the negative rate of vertical margins was 93%. Five-year overall survival rates were as follows: ESD: 64.8%, ESD+AD: 75%, surgery: 86.2%, and CRT: 45.7%, with no statistically significant differences observed. The majority of deaths (83%) were attributed to other diseases or cancers, with only 2 deaths attributed to the primary disease. Conclusion ESD or surgery emerged as the preferred treatment modalities in the majority of cases, with relatively favorable long-term prognoses. Treatment decisions were influenced by comorbidities and other factors, potentially impacting long-term outcomes.
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来源期刊
Diseases of the Esophagus
Diseases of the Esophagus 医学-胃肠肝病学
CiteScore
5.30
自引率
7.70%
发文量
568
审稿时长
6 months
期刊介绍: Diseases of the Esophagus covers all aspects of the esophagus - etiology, investigation and diagnosis, and both medical and surgical treatment.
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