进展期胃癌新辅助化疗后超声内镜下TN分期准确率及化疗前后TN期变化与术后病理反应程度相关性的研究

目的评估超声内镜判断进展期胃癌患者新辅助化疗后TN，分期的准确率并探讨化疗前后TN分期变化与胃癌根治术后病理反应程度的相关性。方法2007年6月至2009年12月间22例进展期胃癌患者在签署知情同意书后首先接受了新辅助化疗，其中男15例i女7例，年龄36—80岁，平均64岁。采取Folfox6化疗方案治疗3个疗程，治疗结束后3～4周全部接受胃癌根治术（R0切除）治疗，化疗前1—2周和手术前1～2周分别对患者行内镜超声检查术（EUS），并进行超声内镜下TN分期判断，以手术病理TN分期为金标准，统计胃癌新辅助化疗后超声内镜下TN分期的准确率，同时对化疗前后超声内镜下TN分期变化与手术后病理反应程度（根据瘤床内出现退变或坏死影响的肿瘤细胞的比例分级，分别计作0、1a和lb、2、3，从0到3表示反应程度逐渐变好）行相关性分析。结果胃癌新辅助化疗后超声内镜下T分期的总体准确率为63．6％（14／22），无一例诊断不足，但存在8例（36．4％，8／22）过度诊断；N分期的总体准确率为54．5％（12／22），有4例（18．2％，4／22）过度诊断和6例（27．3％，6／22）诊断不足。新辅助化疗后有10例超声内镜下TN分期发生降期（以T期＋N期降期例数进行统计，同时发生T期和N期降期时只计作1例），包括9例T期（4例T3期降为T2期，5例T4期降为r乃期）和4例N期（4例N1期降为N0期）降期，发生TN期降期的患者手术后病理反应程度大多较好，其中7例降期患者术后病理反应程度为2，l例降期患者术后病理反应程度为3。结论进展期胃癌新辅助化疗后超声内镜下TN分期的准确率并不高，但化疗后出现超声内镜下TN分期降期的患者手术后病理反应程度大多较好。

Endoscopic ultrasonography for restaging and predicting pathological response to advanced gastric cancer after neoadjuvant chemotherapy

Objective To evaluate endoscopic ultrasonography (EUS) for TN restaging and predicting response to advanced gastric cancer after neoadjuvant chemotherapy. Methods A total of 22 patients,15 males and 7 females, mean age 64 (36-80 years ), with advanced gastric cancer were recruited to the study from June 2007 to December 2009 with written informed consents. All patients underwent 3 cycles of neoadjuvant chemotherapy ( Folfox 6 ), and subsequent surgery ( R0 resction) in 3-4 weeks after chemotherapy. EUS was performed 1-2 weeks before and 1-2 weeks after chemotherapy. EUS TN staging was compared with pathological findings. The correlation of peri-chemotherapy EUS TN staging with postoperative pathological response was evaluated. Results After chemotherapy, the overall accuracy of EUS T staging was 63.6% (14/22), with overstaging (36. 4%, 8/22) more frequent than understaging (0). The overall accuracy of N staging was 54. 5% (12/22) with 4 ( 18. 2%, 4/22) overstaging and 6 ( 27. 3%, 6/22 ) understaging. EUS revealed T and/or N downstaging ( concyrrence of T and N downstaging was accounted once) after chemotherapy in 10 patients, with 9 T downstaging (4 from T3 to T2, 5 from T4 to T3) and 4 N downstaging (4 from N1 to N0). TN downstaging was correlated with pathological response, with 7 patients achieving pathological response 2 and 1 patient 3. Conclusion T and N restaging by EUS after neoadjuvant chemotherapy in patients with locally advanced gastric cancer is not accurate enough. However, T and/or N downstaging confirmed by EUS is well correlated with a better degree of pathological response to chemotherapy.