Multidetector CT for Restaging Locally Advanced Esophageal Squamous Cell Carcinoma and Assessing Therapeutic Response...

Objective To assess the diagnostic accuracy of multidetector CT (MDCT) for restaging of patients with esophageal squamous cell carcinoma (SCC) after neoadjuvant chemotherapy and determine the feasibility of CT for assessing the treatment response and evaluating the prognosis. Methods Totally 135 patients with esophageal SCC who had received neoadjuvant treatment and surgery in Beijing Cancer Hospital from September 2005 to December 2011 were enrolled in this study. TN staging was performed using CT for lesions before and after neoadjuvant treatment by two radiologists,and the tumor regression grade (TRG) and pathological TRG were also assessed. Based on preoperative CT TN restaging results,the patients were defined as responders with T_0-2N₀ after therapy,non-responders with T3-4N+,and patients with undefined response (T_3-4N0 or T_0-2NN₊). Results The accuracy of T and N restaging using CT was 50%,54% (κ=0.718,P <0.001) and 59%,56% (κ=0.753,P <0.001) by two radiologists,respectively. TRG from CT was predicted correctly in 27% of patients. Pathological TRG was an accurate predictor of survival (χ ²=8.13,P=0.04). There was no significant trend toward better survival for lower CT TRG (χ ²=1.17,P=0.286). Among 135 patients with esophageal cancer,19 patients(14.07%) were responders ,46 patients(34.07%) were non-responders,and 70 patients (50.37%)were patients with undefined response . The overall survival rates of responders,non-responders and patients with undefined response were 71.5%,47.3%,and 18.5%,respectively. The overall survival of responders was better than that of patients with undefined response (χ²=1.518,P=0.63) and non-responders(χ²=12.04,P=0.0016),but the overall survival of patients with undefined response was better than that of non-responders (χ²=14.468,P=0.0003). Conclusion sMDCT restaging after neoadjuvant treatment can not accurately predict pathological stage in esophageal SCC. The CT T and N restaging has certain clinical value in assessing the response to neoadjuvant chemotherapy in patients with esophageal cancer and predicting the prognosis.