超声内镜在食管胃结合部腺癌新辅助治疗后肿瘤分期中的应用  

Application of endoscopic ultrasound in tumor staging of adenocarcinoma of the esophagogastric junction after neoadjuvant therapy

作　　者：彭涛[1] 高会斌[1] 娄展 李曙光[3] 翟晓勇 Peng Tao;Gao Huibin;Lou Zhan;Li Shuguang;Zhai Xiaoyong(Department of Digestive Endoscopy,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Neurology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Gastrointestinal Oncology Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Graduate School of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院消化内镜室,张家口075000 [2]河北北方学院附属第一医院神经内科,张家口075000 [3]河北北方学院附属第一医院胃肠肿瘤外科,张家口075000 [4]河北北方学院研究生院,张家口075000

出　　处：《肿瘤研究与临床》2022年第11期826-830,共5页Cancer Research and Clinic

基　　金：张家口市科技计划(2021078D);河北省政府资助临床医学优秀人才培养和基础课题研究项目(361009)。

摘　　要：目的探讨超声内镜(EUS)在食管胃结合部腺癌(AEG)新辅助同步放化疗后肿瘤分期中的应用价值。方法回顾性分析2016年1月至2021年12月河北北方学院附属第一医院40例确诊为Ⅲ期AEG并行新辅助同步放化疗患者的临床资料。应用EUS在患者新辅助同步放化疗后进行术前肿瘤分期,评价治疗效果,并分析其与术后病理分期的一致性。结果40例AEG患者新辅助放化疗后EUS分期为yp-uT_(2)期12例,yp-uT_(3)期18例,yp-uT_(4)期10例;术后病理分期为pT_(1)期2例,pT_(2)期14例,pT_(3)期12例,pT_(4)期12例。以术后病理结果为金标准,EUS对于新辅助放化疗后T分期的准确度为62.5%,其中对于T_(2)期的准确度、灵敏度、特异度分别为58.3%、50.0%、80.8%;T_(3)期的准确度、灵敏度、特异度分别为61.1%、91.7%、75.0%;T_(4)期的准确度、灵敏度、特异度分别为70.0%、58.3%、89.3%。yp-uT分期与pT分期一致性检验Kappa值为0.453。淋巴结EUS分期为yp-uN0期15例,yp-uN_(1)期10例,yp-uN_(2)期10例,yp-uN_(3)期5例;术后病理分期为pN0期18例,pN_(1)期7例,pN_(2)期7例,pN_(3)期8例。以术后病理结果为金标准,EUS对于新辅助放化疗后N分期的准确度为57.5%,其中对于N0期的准确度、灵敏度、特异度分别为73.3%、61.1%、81.8%;N1期的准确度、灵敏度、特异度分别为50.0%、71.4%、84.8%;N2期的准确度、灵敏度、特异度分别为40.0%、57.1%、81.8%;N3期的准确度、灵敏度、特异度分别为60.0%、37.5%、93.8%。yp-uN分期与pN分期一致性检验Kappa值为0.409。结论EUS对于Ⅲ期AEG患者新辅助治疗后T分期的准确性不高,但对T_(3)期有较高的灵敏性,对T_(4)期有较高的特异性。EUS对于Ⅲ期AEG患者新辅助治疗后N分期的灵敏性不高,但对N3期有较高的特异性。Objective To investigate the application value of endoscopic ultrasound(EUS)in tumor staging of adenocarcinoma of the esophagogastric junction(AEG)after neoadjuvant concurrent chemoradiotherapy.Methods The clinical data of 40 patients diagnosed with stageⅢAEG and treated with neoadjuvant concurrent chemoradiotherapy from January 2016 to December 2021 in the First Affiliated Hospital of Hebei North University were retrospectively analyzed.EUS was used to perform preoperative tumor staging after neoadjuvant concurrent chemoradiotherapy to evaluate the therapeutic effect,and the consistency between EUS and postoperative pathological staging was analyzed.Results In 40 AEG patients after neoadjuvant chemoradiotherapy,the EUS staging was stage yp-uT_(2)in 12 cases,stage yp-uT_(3)in 18 cases,and stage yp-uT_(4)in 10 cases.The postoperative pathological staging was stage pT_(1)in 2 cases,stage pT_(2)in 14 cases,stage pT_(3)in 12 cases,and stage pT_(4)in 12 cases.Taking postoperative pathological results as the gold standard,the accuracy of EUS for T staging after neoadjuvant chemoradiotherapy was 62.5%,and the accuracy,sensitivity and specificity for stage T_(2)were 58.3%,50.0%and 80.8%,respectively.The accuracy,sensitivity and specificity for stage T_(3)were 61.1%,91.7%and 75.0%,respectively.The accuracy,sensitivity and specificity for stage T_(4)were 70.0%,58.3%and 89.3%,respectively.The Kappa value of the consistency test between yp-uT staging and pT staging was 0.453.The EUS staging of lymph nodes was stage yp-uN0 in 15 cases,stage yp-uN_(1)in 10 cases,stage yp-uN_(2)in 10 cases,and stage yp-uN_(3)in 5 cases.The postoperative pathological staging was stage pN0 in 18 cases,stage pN_(1)in 7 cases,stage pN_(2)in 7 cases,and stage pN_(3)in 8 cases.Taking postoperative pathological results as the gold standard,the accuracy rate of EUS for N staging after neoadjuvant chemoradiotherapy was 57.5%,and the accuracy,sensitivity and specificity of EUS for stage N0 were 73.3%,61.1%and 81.8%,respectively.The accuracy,sensitivity

关 键 词：腺癌 食管胃接合处 超声内镜 肿瘤分期 肿瘤辅助疗法 

分 类 号：R735[医药卫生—肿瘤]