食管癌术前放化疗后临床再分期的评价

目的探讨食管癌患者术前放化疗（pre-CRT）后采用影像学和内镜检查进行临床再分期的临床价值。方法对27例局部晚期食管鳞癌患者，在接受CRT治疗前采用颈部和胸部及腹部CT、食管超声内镜（EUS）、电子气管镜及PET-CT等检查进行临床分期；完成pre-CRT后再次进行分期。临床疗效评价采用RECIST标准，放化疗后3～6周施行手术，将术后病理结果与术前分期进行对照研究。对常规病理学检测为pT0和pN0病例的组织切片，采用免疫组织化学（免疫组化）染色检测原发灶及淋巴结中的微小肿瘤残留灶。结果全组pre．CRT后，CT对T及N分期的准确率分别为40．9％（9／22）和68．2％（15／22），总的分期准确率为40．9％（9／22）；EUS对T及N分期的准确率分别为38．5％（5／13）和69．2％（9／13），总的分期准确率为38．5％（5／13）。联合CT和EUS总的分期准确率为46．2％（6／13）。CRT结束后临床评价完全缓解（CR）5例，部分缓解（PR）14例，无缓解（SD）8例。5例临床评价cR者术后病理证实3例CR，1例pT3N1，1例虽经苏木精．伊红染色为pT0N0，但经免疫组化检测发现淋巴结存在微小肿瘤病灶残留。而术后病理结果pCR的5例患者中，除3例术前评价为CR外。另2例术前临床评价为PR。在15例N0的病例中，免疫组化检测有2例3个淋巴结仍可见食管癌细胞分布于其周边。结论目前常用的临床检查分期手段（食管吞钡、CT、EUS、内镜下病理活检等）和临床疗效评价手段（RECIST标准）对食管癌放化疗后的肿瘤组织反应评价准确率不高。建议CRT后临床评价食管癌CR的患者。仍应接受手术治疗。

Evaluation of the clinical staging for esophageal carcinoma after preoperative chemoradiation therapy

Objective To evaluate the accuracy of radiographic examination, endoscopic examination and clinical response evaluation criteria in staging for esophageal carcinoma after preoperative chemoradiation therapy (prc-CRT). Methods Twenty-seven patients of locally advanced esophageal squamous cell carcinoma were involved. CT scan for cervical part, chest and abdomen, and endoscopic ultrasound (EUS), electronic fibrobroncoscopic examination were used to assess the tumor for staging before pre-CRT. The tumors were re-assessed using the same methods after the completion of CRT. Response evaluation criteria in solid tumors(RECIST) was used to assess the tumor response. Surgery was carried out 3 to 6 weeks after CRT. The clinical tumor response before surgery was compared with pathological tumor response after surgery. Micromctastasis detection was carried out for paraffin embedded lymph nodes using anti-keratin monoclonal marker AE1 and AE3 by immunohistochemical(IHC) method. Results The accuracy of CT scan in staging after pre-CRT was 40.9% (9/22) for primary tumors and 68.2% (15/22)for lymph nodes, with overall accuracy of 40.9%(9/22) for TNM staging. The accuracy of EUS in staging was 38.5%(5/13) for primary tumors and 69.2%(9/13) for lymph nodes, with overall accuracy of 38.5%(5/13)for TNM staging. While CT scan combined with EUS, the accuracy for TNM staging was 46.2%(6/13). Five cases achieved CR, 14 cases achieved PR and 8 cases achieved SD according to RECIST. Among 5 clinical CR cases, 3 cases were confirmed by pathologic examination, 1 case was diagnosed as pT3N disease by HE stain. One case with pT0N0 disease by HE stain was detected with lymph node micrometastasis by IHC. Among 5 pathological CR cases, 3 cases were diagnosed as clinical CR, 2 cases were diagnosed as clinical PR before surgery. Among 15 cases of No disease by HE stain, 3 lymph nodes from 2 cases were detected with micrometastasis by IHC. Conclusions The current examinations (barium swallow, CT scan, EUS, endoscopy guided biopsy) and RECIST are not accurate enough to assess the tumor response for esophageal squamous cell carcimona after pre-CRT. Surgery should be recommended for patients with clinical CR after pre-CRT.