Maligne Neoplasien des Verdauungstrakts - neue Aspekte zum endosonografischen Staging

Jenssen, Christian; Dietrich, C. F.; Burmester, Eike

doi:10.1055/s-0029-1245870

Cited by 13 publications

(2 citation statements)

References 49 publications

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“…Tumor invasion beyond the muscularis propria was defined as T3 and adjacent organ involvement as T4. Due to invisibility of the serosa on EUS, assessment of serosa involvement in gastric cancers is limited [25]. Consequently, Jürgensen C et al recommended classifying tumor extension beyond the muscularis propria up to 4 mm as uT3, infiltration greater than 4 mm as uT4, and infiltration of adjacent organs as uT4b [26].…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Preoperative Endoscopic Ultrasound (EUS) After Neoadjuvant Chemotherapy in Locally Advanced Esophagogastric Cancer – Data From a Randomized German Phase II Trial

et al. 2022

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Purpose The role of EUS before or after neoadjuvant chemotherapy (nCTX) in advanced esophagogastric cancer (EGC) is still unclear. The phase II NEOPECX trial evaluated perioperative chemotherapy with or without panitumumab in this setting. The aim of this sub-study was to investigate the prognostic value of EUS-guided preoperative staging before and after nCTX. Materials and Methods Preoperative yuT/yuN stages by EUS were compared with histopathological ypT/ypN stages after curative resection. Reduction in T-stage from baseline to preoperative EUS was defined as downstaging (DS+) and compared to progression-free (PFS) and overall survival (OS) of patients without downstaging (DS-). In addition, preoperative EUS N-stages (positive N+ or negative N-) were correlated with clinical data. Results The preoperative yuT-stage correlated with the ypT-stage in 48% of cases (sensitivity 48%, specificity 52%), while the preoperative yuN-stage correlated with the ypN-stage in 64% (sensitivity 76%, specificity 52%). Within DS+ patients who were downstaged by ≥ 2 T-categories, a trend towards improved OS was detected (median OS DS+: not reached (NR), median OS DS-: 38.5 months (M), p=0.21). Patients with yuN+ at preoperative EUS had a worse outcome than yuN- patients (median OS yuN-: NR, median OS yuN+: 38.5 M, p = 0.013). Conclusion The diagnostic accuracy of EUS to predict the response after nCTX in patients with advanced EGC is limited. In the current study the endosonographic detection of lymph node metastasis after nCTX indicates a poor prognosis. In the future, preoperative EUS with sectional imaging procedures may be used to tailor treatment for patients with advanced EGC.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of Preoperative Endoscopic Ultrasound (EUS) After Neoadjuvant Chemotherapy in Locally Advanced Esophagogastric Cancer – Data From a Randomized German Phase II Trial

et al. 2022

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“…Dies führt allerdings dazu, dass auch Kliniker (Gastroenterologen, Pneumologen, Onkologen) sich auf das jeweils neueste TNM-System einstellen und die Befunde beispielsweise von endoskopischem und endobronchialem Ultraschall (EUS, EBUS) anpassen müssen. So hat es in den letzten Jahren insbesondere im Staging des Ösophagus- und Magenkarzinoms erhebliche Änderungen gegeben, die sich teilweise erst mit einiger Latenz flächendeckend in der klinischen Praxis durchgesetzt haben 13 . Andererseits zeigt das Beispiel des Rektumkarzinoms, dass auch das TNM-System teilweise durch Entwicklungen in Leitlinien „überholt“ werden kann.…”

Section: Andere Klassifikationssysteme Und Weiterentwicklung Des Tnm-systemsunclassified