演題抄録

International Workshop

開催概要
開催回
第54回・2016年・横浜
 

Accuracy of clinical diagnosis of T factor in locally advanced unresectable esophageal cancer from COSMOS trial

演題番号 : IWS3-6

[筆頭演者]
横田 知哉:1 
[共同演者]
安田 卓司:2、加藤 広行:3、野崎 功雄:4、佐藤 弘:5、宮田 佳典:6、黒木 嘉典:7、加藤 健:8、浜本 康夫:9、坪佐 恭宏:10、小川 洋史:11、伊藤 芳紀:12、北川 雄光:13

1:静岡県立静岡がんセンター・消化器内科、2:近畿大学・医学部・外科学教室、3:獨協医科大学・第一外科、4:独立行政法人国立病院機構四国がんセンター・消化器外科、5:埼玉医科大学国際医療センター・上部消化管外科、6:長野県厚生農業協同組合連合会佐久総合病院・腫瘍内科、7:福岡大学・医学部・放射線医学教室、8:国立研究開発法人国立がん研究センター中央病院・消化管内科、9:慶応義塾大学医学部・消化器内科、10:静岡県立静岡がんセンター・食道外科、11:静岡県立静岡がんセンター・放射線治療科、12:国立研究開発法人国立がん研究センター中央病院・放射線治療部、13:慶応義塾大学医学部・一般・消化器外科

 

Background: We conducted a multicenter phase II trial assessing the safety and efficacy of chemoselection with docetaxel plus 5-fluorouracil and cisplatin induction chemotherapy and subsequent conversion surgery for locally advanced esophageal cancer with clinical T4 and/or unresectable supraclavicular lymph node metastasis (COSMOS trial). However, accurate clinical evaluation of T factor (i.e., T3 or T4) is crucial for curative resection of locally advanced esophageal cancer.
Methods: 48 patients assigned to COSMOS trial were studied to evaluate the concordance between pretreatment clinical T diagnosis by investigators and that by the objective assessment. Each of computed tomography scans and esophagoscopic images taken at baseline was retrospectively reviewed by 6 senior physicians with experience in esophageal oncology. Individual reviewers were blinded to the patients' clinical outcome data, and to the voting of other reviewers. The reviewers voted for; definitive T4, relative T4, relative T3, or definitive T3. Discordant assessments among reviewers were resolved by the majority opinion.
Results: 90% of assigned patients were diagnosed as clinical T4 by investigators, while 33.3-75.0% (median 70.8%) of patients were judged to be T4 by 6 reviewers. Disagreement of diagnosis between investigators and reviewers occurred in 33% (16/48) of all patients, including 12 patients in whom curative resection was considered possible (48%, n=25), and 4 patients in whom curative resection was considered impossible (17%, n=23). Critical disagreement of diagnosis (one reviewer voted for definitive T3 or T4, but the other for opposite definitive T4 or T3, respectively) between investigators and each reviewer occurred in 8.3-29.2% (median 10.4%). However, critical disagreement between reviewers occurred only in 0-12.5% (median 2.1%).
Conclusion: There was inter-observers variation in clinical diagnosis of T factor for patients with locally advanced unresectable esophageal cancer.

キーワード

臓器別:食道

手法別:診断

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