Response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound does not accurately predict histopathologic regression after neoadjuvant chemoradiation for esophageal cancer
To prospectively assess the sensitivity (sens), specificity (spec), positive predictive value (ppv), negative predictive value (npv), and accuracy (acc) for clinical response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound (EUS) to determine histomorphologic regression UICC T-category d...
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| Veröffentlicht in: | Annals of surgery 2008-12, Vol.248 (6), p.902-908 |
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| creator | Schneider, Paul M Metzger, Ralf Schaefer, Hartmut Baumgarten, Frank Vallbohmer, Daniel Brabender, Jan Wolfgarten, Eva Bollschweiler, Elfriede Baldus, Stephan E Dienes, Hans P Hoelscher, Arnulf H |
| description | To prospectively assess the sensitivity (sens), specificity (spec), positive predictive value (ppv), negative predictive value (npv), and accuracy (acc) for clinical response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound (EUS) to determine histomorphologic regression UICC T-category downstaging after neoadjuvant chemoradiation for esophageal cancer.
Histomorphologic regression is meanwhile established as objective parameter for response and prognosis after neoadjuvant chemoradiation for esophageal cancer.
Within a prospective observation trial, 80 patients with localized esophageal cancers (cT2-4,Nx,M0) received standardized neoadjuvant chemoradiation (cisplatin, 5-fluorouracil, 36 Gy) and were resected by transthoracic en bloc esophagectomy and two-field lymphadenectomy. Tumor regression was based on the percentage of vital residual tumor cells and classified in 4 categories as reported previously. Evaluation by endoscopy and EUS was performed based on WHO/UICC criteria before starting chemoradiation and before resection and rebiopsies were taken at the time of re-endoscopy.
Histomorphologic response was of significant (log rank) prognostic importance (P < 0.001), whereas clinical response evaluation by endoscopy (P = 0.1), rebiopsy (P = 0.34), and EUS (P = 0.35) was not. The results of the 3 diagnostic modalities to assess histomorphologic regression by endoscopy and rebiopsy UICC ypT-category downstaging for EUS are summarized: Endoscopy: sens 60%, spec 34%, ppv 49%, npv 44%, acc 47%. Rebiopsy: sens 36%, spec 100%, ppv 100%, npv 24%, acc 47%. EUS: sens 7%, spec 79%, ppv 18%, npv 57%, acc 50%.
Histomorphologic regression is an objective response parameter of significant prognostic importance. The diagnostic accuracy of endoscopy, rebiopsy, and EUS is inadequate for objective response evaluation after neoadjuvant chemoradiation and can be omitted for this purpose in the clinical practice. |
| doi_str_mv | 10.1097/SLA.0b013e31818f3afb |
| format | Article |
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Histomorphologic regression is meanwhile established as objective parameter for response and prognosis after neoadjuvant chemoradiation for esophageal cancer.
Within a prospective observation trial, 80 patients with localized esophageal cancers (cT2-4,Nx,M0) received standardized neoadjuvant chemoradiation (cisplatin, 5-fluorouracil, 36 Gy) and were resected by transthoracic en bloc esophagectomy and two-field lymphadenectomy. Tumor regression was based on the percentage of vital residual tumor cells and classified in 4 categories as reported previously. Evaluation by endoscopy and EUS was performed based on WHO/UICC criteria before starting chemoradiation and before resection and rebiopsies were taken at the time of re-endoscopy.
Histomorphologic response was of significant (log rank) prognostic importance (P < 0.001), whereas clinical response evaluation by endoscopy (P = 0.1), rebiopsy (P = 0.34), and EUS (P = 0.35) was not. The results of the 3 diagnostic modalities to assess histomorphologic regression by endoscopy and rebiopsy UICC ypT-category downstaging for EUS are summarized: Endoscopy: sens 60%, spec 34%, ppv 49%, npv 44%, acc 47%. Rebiopsy: sens 36%, spec 100%, ppv 100%, npv 24%, acc 47%. EUS: sens 7%, spec 79%, ppv 18%, npv 57%, acc 50%.
Histomorphologic regression is an objective response parameter of significant prognostic importance. The diagnostic accuracy of endoscopy, rebiopsy, and EUS is inadequate for objective response evaluation after neoadjuvant chemoradiation and can be omitted for this purpose in the clinical practice.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0b013e31818f3afb</identifier><identifier>PMID: 19092334</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Aged ; Biopsy ; Carcinoma, Squamous Cell - pathology ; Chemotherapy, Adjuvant ; Endosonography ; Esophageal Neoplasms - drug therapy ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - radiotherapy ; Esophageal Neoplasms - surgery ; Esophagectomy ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Prognosis ; Radiotherapy Dosage ; Radiotherapy, Adjuvant ; Risk Assessment ; Sensitivity and Specificity ; Young Adult</subject><ispartof>Annals of surgery, 2008-12, Vol.248 (6), p.902-908</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c305t-324dd357ba7940057ae25afb885cbe4823c8e870f25ebedbac850564d5b1cc5d3</citedby><cites>FETCH-LOGICAL-c305t-324dd357ba7940057ae25afb885cbe4823c8e870f25ebedbac850564d5b1cc5d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19092334$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schneider, Paul M</creatorcontrib><creatorcontrib>Metzger, Ralf</creatorcontrib><creatorcontrib>Schaefer, Hartmut</creatorcontrib><creatorcontrib>Baumgarten, Frank</creatorcontrib><creatorcontrib>Vallbohmer, Daniel</creatorcontrib><creatorcontrib>Brabender, Jan</creatorcontrib><creatorcontrib>Wolfgarten, Eva</creatorcontrib><creatorcontrib>Bollschweiler, Elfriede</creatorcontrib><creatorcontrib>Baldus, Stephan E</creatorcontrib><creatorcontrib>Dienes, Hans P</creatorcontrib><creatorcontrib>Hoelscher, Arnulf H</creatorcontrib><title>Response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound does not accurately predict histopathologic regression after neoadjuvant chemoradiation for esophageal cancer</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>To prospectively assess the sensitivity (sens), specificity (spec), positive predictive value (ppv), negative predictive value (npv), and accuracy (acc) for clinical response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound (EUS) to determine histomorphologic regression UICC T-category downstaging after neoadjuvant chemoradiation for esophageal cancer.
Histomorphologic regression is meanwhile established as objective parameter for response and prognosis after neoadjuvant chemoradiation for esophageal cancer.
Within a prospective observation trial, 80 patients with localized esophageal cancers (cT2-4,Nx,M0) received standardized neoadjuvant chemoradiation (cisplatin, 5-fluorouracil, 36 Gy) and were resected by transthoracic en bloc esophagectomy and two-field lymphadenectomy. Tumor regression was based on the percentage of vital residual tumor cells and classified in 4 categories as reported previously. Evaluation by endoscopy and EUS was performed based on WHO/UICC criteria before starting chemoradiation and before resection and rebiopsies were taken at the time of re-endoscopy.
Histomorphologic response was of significant (log rank) prognostic importance (P < 0.001), whereas clinical response evaluation by endoscopy (P = 0.1), rebiopsy (P = 0.34), and EUS (P = 0.35) was not. The results of the 3 diagnostic modalities to assess histomorphologic regression by endoscopy and rebiopsy UICC ypT-category downstaging for EUS are summarized: Endoscopy: sens 60%, spec 34%, ppv 49%, npv 44%, acc 47%. Rebiopsy: sens 36%, spec 100%, ppv 100%, npv 24%, acc 47%. EUS: sens 7%, spec 79%, ppv 18%, npv 57%, acc 50%.
Histomorphologic regression is an objective response parameter of significant prognostic importance. The diagnostic accuracy of endoscopy, rebiopsy, and EUS is inadequate for objective response evaluation after neoadjuvant chemoradiation and can be omitted for this purpose in the clinical practice.</description><subject>Adult</subject><subject>Aged</subject><subject>Biopsy</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Chemotherapy, Adjuvant</subject><subject>Endosonography</subject><subject>Esophageal Neoplasms - drug therapy</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - radiotherapy</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Prognosis</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy, Adjuvant</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>Young Adult</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUcuK3DAQFCEhO9nkD0LQKad407KksXxclrxgIJDH2bSk9owXj-Wo5YX5rvxgvMyQQE7ddFdVF11CvFZwo6Bt3n_f3d6AB6VJK6dcr7H3T8RG2dpVShl4KjYAoCvT6vpKvGC-B1DGQfNcXKkW2lprsxG_vxHPaWKS9IDjgmVIk_QnSVNMHNJ8eicz-SHNvHY4xb-LIchlLBk5Les0JmI5pSIxhCVjofEk50xxCEUeBi5pxnJIY9qvtEz7TMyPh7AvlOVECeP98oBTkeFAx5QxDmcnfcqSOM0H3BOOMuAUKL8Uz3ocmV5d6rX4-fHDj7vP1e7rpy93t7sqaLCl0rWJUdvGY9MaANsg1XZ9knM2eDKu1sGRa6CvLXmKHoOzYLcmWq9CsFFfi7dn3TmnXwtx6Y4DBxpHXB0v3G3bVsFW2RVozsCQE3OmvpvzcMR86hR0j2F1a1jd_2GttDcX_cUfKf4jXdLRfwAnmpjb</recordid><startdate>200812</startdate><enddate>200812</enddate><creator>Schneider, Paul M</creator><creator>Metzger, Ralf</creator><creator>Schaefer, Hartmut</creator><creator>Baumgarten, Frank</creator><creator>Vallbohmer, Daniel</creator><creator>Brabender, Jan</creator><creator>Wolfgarten, Eva</creator><creator>Bollschweiler, Elfriede</creator><creator>Baldus, Stephan E</creator><creator>Dienes, Hans P</creator><creator>Hoelscher, Arnulf H</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200812</creationdate><title>Response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound does not accurately predict histopathologic regression after neoadjuvant chemoradiation for esophageal cancer</title><author>Schneider, Paul M ; Metzger, Ralf ; Schaefer, Hartmut ; Baumgarten, Frank ; Vallbohmer, Daniel ; Brabender, Jan ; Wolfgarten, Eva ; Bollschweiler, Elfriede ; Baldus, Stephan E ; Dienes, Hans P ; Hoelscher, Arnulf H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-324dd357ba7940057ae25afb885cbe4823c8e870f25ebedbac850564d5b1cc5d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biopsy</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Chemotherapy, Adjuvant</topic><topic>Endosonography</topic><topic>Esophageal Neoplasms - drug therapy</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - radiotherapy</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Prognosis</topic><topic>Radiotherapy Dosage</topic><topic>Radiotherapy, Adjuvant</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schneider, Paul M</creatorcontrib><creatorcontrib>Metzger, Ralf</creatorcontrib><creatorcontrib>Schaefer, Hartmut</creatorcontrib><creatorcontrib>Baumgarten, Frank</creatorcontrib><creatorcontrib>Vallbohmer, Daniel</creatorcontrib><creatorcontrib>Brabender, Jan</creatorcontrib><creatorcontrib>Wolfgarten, Eva</creatorcontrib><creatorcontrib>Bollschweiler, Elfriede</creatorcontrib><creatorcontrib>Baldus, Stephan E</creatorcontrib><creatorcontrib>Dienes, Hans P</creatorcontrib><creatorcontrib>Hoelscher, Arnulf H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schneider, Paul M</au><au>Metzger, Ralf</au><au>Schaefer, Hartmut</au><au>Baumgarten, Frank</au><au>Vallbohmer, Daniel</au><au>Brabender, Jan</au><au>Wolfgarten, Eva</au><au>Bollschweiler, Elfriede</au><au>Baldus, Stephan E</au><au>Dienes, Hans P</au><au>Hoelscher, Arnulf H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound does not accurately predict histopathologic regression after neoadjuvant chemoradiation for esophageal cancer</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2008-12</date><risdate>2008</risdate><volume>248</volume><issue>6</issue><spage>902</spage><epage>908</epage><pages>902-908</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>To prospectively assess the sensitivity (sens), specificity (spec), positive predictive value (ppv), negative predictive value (npv), and accuracy (acc) for clinical response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound (EUS) to determine histomorphologic regression UICC T-category downstaging after neoadjuvant chemoradiation for esophageal cancer.
Histomorphologic regression is meanwhile established as objective parameter for response and prognosis after neoadjuvant chemoradiation for esophageal cancer.
Within a prospective observation trial, 80 patients with localized esophageal cancers (cT2-4,Nx,M0) received standardized neoadjuvant chemoradiation (cisplatin, 5-fluorouracil, 36 Gy) and were resected by transthoracic en bloc esophagectomy and two-field lymphadenectomy. Tumor regression was based on the percentage of vital residual tumor cells and classified in 4 categories as reported previously. Evaluation by endoscopy and EUS was performed based on WHO/UICC criteria before starting chemoradiation and before resection and rebiopsies were taken at the time of re-endoscopy.
Histomorphologic response was of significant (log rank) prognostic importance (P < 0.001), whereas clinical response evaluation by endoscopy (P = 0.1), rebiopsy (P = 0.34), and EUS (P = 0.35) was not. The results of the 3 diagnostic modalities to assess histomorphologic regression by endoscopy and rebiopsy UICC ypT-category downstaging for EUS are summarized: Endoscopy: sens 60%, spec 34%, ppv 49%, npv 44%, acc 47%. Rebiopsy: sens 36%, spec 100%, ppv 100%, npv 24%, acc 47%. EUS: sens 7%, spec 79%, ppv 18%, npv 57%, acc 50%.
Histomorphologic regression is an objective response parameter of significant prognostic importance. The diagnostic accuracy of endoscopy, rebiopsy, and EUS is inadequate for objective response evaluation after neoadjuvant chemoradiation and can be omitted for this purpose in the clinical practice.</abstract><cop>United States</cop><pmid>19092334</pmid><doi>10.1097/SLA.0b013e31818f3afb</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Biopsy Carcinoma, Squamous Cell - pathology Chemotherapy, Adjuvant Endosonography Esophageal Neoplasms - drug therapy Esophageal Neoplasms - pathology Esophageal Neoplasms - radiotherapy Esophageal Neoplasms - surgery Esophagectomy Female Humans Male Middle Aged Neoadjuvant Therapy Neoplasm Staging Prognosis Radiotherapy Dosage Radiotherapy, Adjuvant Risk Assessment Sensitivity and Specificity Young Adult |
| title | Response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound does not accurately predict histopathologic regression after neoadjuvant chemoradiation for esophageal cancer |
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