食道癌:临床分期的不准确性是否会影响我们达到最佳结果的能力?
James Swanson1, Siena Roat-Shumway1, Tyler Cohn2
1Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
Surgery
|November 6, 2023
概括
在早期食道癌中,不准确的临床分期影响了治疗决策和结果. 瘤大小和组织学是导致升级的关键因素,减少了最佳的瘤结果.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 癌症的分期 癌症的分期
背景情况:
- 预治疗临床分期指导早期食道癌的治疗.
- 不准确的分期对瘤结局的影响还没有得到充分的研究.
研究的目的:
- 评估不准确的临床分期对早期食道癌患者的瘤结果的影响.
- 为了确定与食道癌的临床升级相关的因素.
主要方法:
- 利用国家癌症数据库 (2010-2019) 确定患有临床阶段cT1bN0食道癌的患者进行食道切除术.
- 根据临床和最终病理阶段之间的差异来定义升级阶段.
- 建立了"教科书瘤结果"标准,包括边缘阴性切除,充分的淋巴结检查和适当的新辅助疗法使用.
主要成果:
- 在916名患者中,超过41%的患者经历了临床升级.
- 预测上升阶段的因素包括晚期呈现,延迟手术,较大的瘤大小 (>2厘米),以及缺陷的组织学.
- 教科书瘤结局的比率从43.8%下降到22.5%,当考虑升级时.
结论:
- 瘤大小和组织学是cT1bN0食道癌中不准确的治疗前临床分期的重要预测因素.
- 临床分期的不准确性大大降低了获得最佳瘤治疗结果的可能性.
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