Skip to main content

Prätherapeutische Fehlklassifikationen bei Ösophaguskarzinomen und Adenokarzinomen des ösophagogastralen Übergangs

Möglichkeiten und klinische Konsequenzen

Pretherapeutic misclassification of esophageal cancer and adenocarcinoma of the esophagogastric junction

Possibilities and clinical consequences

Der Chirurg volume 91, pages 41–50 (2020)Cite this article

Zusammenfassung

Im Verlauf der Erkrankungen von Krebspatienten gibt es Zeitpunkte, an denen verschiedene Tumorklassifikationen erstellt werden müssen. Diese Klassifikationen erfüllen unterschiedliche Zwecke, von denen besonders die Wahl der Therapie und die Vorhersage der Prognose wichtig sind. Vielfältige Erfahrungen haben gezeigt, dass bei der Anwendung von Tumorklassifikationen zahlreiche Probleme auftreten können, die zu Konsequenzen bei den betroffenen Patienten führen können, auch bei Patienten mit Ösophaguskarzinomen und Adenokarzinomen des ösophagogastralen Übergangs (AEG).

Abstract

During the course of a malignant disease, the tumor needs to be classified repeatedly in order to facilitate decision-making in treatment and to estimate patients prognosis; however, a wrong classification of tumors can occur in different stages of the disease course with tremendous consequences for the affected patients. This review discusses the possible misclassifications which can occur in patients with esophageal cancer or adenocarcinoma of the esophagogastric junction (EGJ), along with the consequences.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Abb. 1
Abb. 2

Literatur

  1. Becker K, Langer R, Reim D et al (2011) Significance of histopathological tumor regression after neoadjuvant chemotherapy in gastric adenocarcinomas: a summary of 480 cases. Ann Surg 253(5):934–939

    Article  Google Scholar 

  2. Becker K, Mueller JD, Schulmacher C et al (2003) Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer 98(7):1521–1530

    Article  Google Scholar 

  3. Brierley JD, Gospodarowicz MK, Wittekind C (Hrsg) (2016) TNM classification of malignant tumours, 8. Aufl. John Wiley & Sons, New York

    Google Scholar 

  4. Brücher BLDM, Becker K, Lordick F et al (2006) The clinical impact of histopathologic response assessment by residual tumor cell quantification in esophageal squamous cell carcinomas. Cancer 106(10):2119–2127

    Article  Google Scholar 

  5. Cuellar SLB, Carter BW, Macapinlac HA et al (2014) Clinical staging of patients with early esophageal adenocarcinoma: Does FDG-PET/CT have a role? J Thorac Oncol 9(8):1202–1206

    Article  CAS  Google Scholar 

  6. Davies AR, Gossage JA, Zylstra J et al (2014) Tumor stage after neoadjuvant chemotherapy determines survival after surgery for adenocarcinoma of the esophagus and esophagogastric junction. J Clin Oncol 32(27):2983–2990

    Article  Google Scholar 

  7. Grotenhuis BA, Wijnhoven BPL, Poley JW et al (2013) Preoperative assessment of tumor location and station-specific lymph node status in patients with adenocarcinoma of the gastroesophageal junction. World J Surg 37(1):147–155

    Article  Google Scholar 

  8. van Hagen P, Hulshof MCCM, van Lanschot JJB et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(22):2074–2084

    Article  Google Scholar 

  9. Hamilton SR, Aaltonen LA (2000) World Health Organization Classification of tumours. Pathology and genetics of tumours of the digestive system. IARC Press, Lyon

    Google Scholar 

  10. Hölscher AH, Bollschweiler E, Bogoevski D et al (2014) Prognostic impact of neoadjuvant chemoradiation in cT3 oesophageal cancer—a propensity score matched analysis. Eur J Cancer 50(17):2950–2957

    Article  Google Scholar 

  11. Hölscher AH, Drebber U, Schmidt H et al (2014) Prognostic classification of histopathologic response to neoadjuvant therapy in esophageal adenocarcinoma. Ann Surg 260(5):779–784 (discussion 784–5)

    Article  Google Scholar 

  12. Junginger T, Hermanek P, Klimpfinger M (2002) Klassifikation maligner Tumoren des Gastrointestinaltrakts. Klassifikation maligner Tumoren des Gastrointestinaltrakts Bd. 1. Springer, Berlin

    Book  Google Scholar 

  13. Langer R, Becker K, Zlobec I et al (2014) A multifactorial histopathologic score for the prediction of prognosis of resected esophageal adenocarcinomas after neoadjuvant chemotherapy. Ann Surg Oncol 21(3):915–921

    Article  Google Scholar 

  14. Langer R, Ott K, Feith M et al (2009) Prognostic significance of histopathological tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas. Mod Pathol 22(12):1555–1563

    Article  CAS  Google Scholar 

  15. Lordick F, Mariette C, Haustermans K et al (2016) Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 27(suppl 5):v50–v57

    Article  CAS  Google Scholar 

  16. Lordick F, Ott K, Krause B‑J et al (2007) PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase II trial. Lancet Oncol 8(9):797–805

    Article  Google Scholar 

  17. Mandard AM, Dalibard F, Mandard JC et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 73(11):2680–2686

    Article  CAS  Google Scholar 

  18. Moehler M, Al-Batran S‑E, Andus T et al (2011) S3-Leitlinie „Magenkarzinom“ – Diagnostik und Therapie der Adenokarzinome des Magens und ösophagogastralen Übergangs (AWMF-Regist.-Nr. 032-009-OL) (German S3-guideline „Diagnosis and treatment of esophagogastric cancer“). Z Gastroenterol 49(4):461–531

    Article  CAS  Google Scholar 

  19. Ngamruengphong S, Sharma VK, Nguyen B et al (2010) Assessment of response to neoadjuvant therapy in esophageal cancer: an updated systematic review of diagnostic accuracy of endoscopic ultrasonography and fluorodeoxyglucose positron emission tomography. Dis Esophagus 23(3):216–231

    Article  CAS  Google Scholar 

  20. Ott K, Weber WA, Lordick F et al (2006) Metabolic imaging predicts response, survival, and recurrence in adenocarcinomas of the esophagogastric junction. J Clin Oncol 24(29):4692–4698

    Article  Google Scholar 

  21. Parry K, Haverkamp L, Bruijnen RCG et al (2016) Staging of adenocarcinoma of the gastroesophageal junction. Eur J Surg Oncol 42(3):400–406

    Article  CAS  Google Scholar 

  22. Plum PS, Hölscher AH, Pacheco Godoy K et al (2018) Prognosis of patients with superficial T1 esophageal cancer who underwent endoscopic resection before esophagectomy—a propensity score-matched comparison. Surg Endosc 32(9):3972–3980

    Article  Google Scholar 

  23. Porschen R, Buck A, Fischbach W et al (2015) S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus (Langversion 1.0 – September 2015, AWMF-Registernummer: 021/023OL) (Not Available). Z Gastroenterol 53(11):1288–1347

    Article  CAS  Google Scholar 

  24. Porschen R, Fischbach W, Gockel I et al (2019) S3-Leitlinie – Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. Z Gastroenterol 57(3):336–418

    Article  Google Scholar 

  25. Puli SR, Reddy JB, Bechtold ML et al (2008) Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. World J Gastroenterol 14(10):1479–1490

    Article  Google Scholar 

  26. Qumseya BJ, Brown J, Abraham M et al (2015) Diagnostic performance of EUS in predicting advanced cancer among patients with Barrett’s esophagus and high-grade dysplasia/early adenocarcinoma: systematic review and meta-analysis. Gastrointest Endosc 81(4):865–874.e2

    Article  Google Scholar 

  27. van Rossum PSN, Goense L, Meziani J et al (2016) Endoscopic biopsy and EUS for the detection of pathologic complete response after neoadjuvant chemoradiotherapy in esophageal cancer: a systematic review and meta-analysis. Gastrointest Endosc 83(5):866–879

    Article  Google Scholar 

  28. Schröder W, Bollschweiler E, Kossow C et al (2006) Preoperative risk analysis—A reliable predictor of postoperative outcome after transthoracic esophagectomy? Langenbecks Arch Surg 391(5):455–460

    Article  Google Scholar 

  29. Sobin LH, Gospodarowicz MK, Wittekind C (Hrsg) (2009) TNM Classification of Malignant Tumours Bd. 7. John Wiley & Sons, New York

    Google Scholar 

  30. Spoerl S, Novotny A, Al-Batran S‑E et al (2018) Histopathological regression predicts treatment outcome in locally advanced esophagogastric adenocarcinoma. Eur J Cancer 90:26–33

    Article  Google Scholar 

  31. Thosani N, Singh H, Kapadia A et al (2012) Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. Gastrointest Endosc 75(2):242–253

    Article  Google Scholar 

  32. van Vliet EPM, Heijenbrok-Kal MH, Hunink MGM et al (2008) Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer 98(3):547–557

    Article  Google Scholar 

  33. Wittekind C (Hrsg) (2017) TNM – Klassifikation maligner Tumoren, 8. Aufl. Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim

    Google Scholar 

  34. Wittekind C, Compton C, Brierley JD et al (Hrsg) (2012) TNM supplement: a commentary on uniform use, 4. Aufl. John Wiley & Sons, New York

    Google Scholar 

  35. Wu T‑T, Chirieac LR, Abraham SC et al (2007) Excellent interobserver agreement on grading the extent of residual carcinoma after preoperative chemoradiation in esophageal and esophagogastric junction carcinoma: a reliable predictor for patient outcome. Am J Surg Pathol 31(1):58–64

    Article  Google Scholar 

  36. Young PE, Gentry AB, Acosta RD et al (2010) Endoscopic ultrasound does not accurately stage early adenocarcinoma or high-grade dysplasia of the esophagus. Clin Gastroenterol Hepatol 8(12):1037–1041

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    I. Gockel MBA, O. Lyros & N. Kreuser

  2. Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    F. Lordick

  3. Zentrum für Speiseröhren- und Magenchirurgie, Agaplesion Markus-Krankenhaus, Frankfurt a.M., Deutschland

    A. H. Hölscher

  4. Contilia Zentrum für Speiseröhrenerkrankungen, Elisabeth-Krankenhaus Essen, Essen, Deutschland

    A. H. Hölscher

  5. Institut für Pathologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    C. Wittekind

Authors
  1. I. Gockel MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Lordick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Lyros
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Kreuser
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. H. Hölscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Wittekind
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Gockel MBA.

Ethics declarations

Interessenkonflikt

I. Gockel, F. Lordick, O. Lyros, N. Kreuser, A.H. Hölscher und C. Wittekind geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gockel, I., Lordick, F., Lyros, O. et al. Prätherapeutische Fehlklassifikationen bei Ösophaguskarzinomen und Adenokarzinomen des ösophagogastralen Übergangs. Chirurg 91, 41–50 (2020). https://doi.org/10.1007/s00104-019-1011-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-019-1011-4

Schlüsselwörter

  • Ösophaguskarzinome
  • Adenokarzinome des ösophagogastralen Übergangs (AEG)
  • Tumorfehlklassifikationen
  • Tumorstaging
  • TNM-Klassifikation

Keywords

  • Esophageal cancer
  • Adenocarcinoma of the esophagogastric junction (EGJ)
  • Tumor misclassification
  • Tumor staging
  • TNM classification