Background and Objectives:The Esophageal Adenocarcinoma Study Group Europe (EACSGE) recently proposed a granular histologic classification of esophageal–esophago-gastric junctional adenocarcinomas (EA-EGJAs) based on the study of naïve surgically resected specimens that, when combined with the pTNM stage, is an efficient indicator of prognosis, molecular events, and response to treatment. In this study, we compared histologic classes of endoscopic biopsies taken before surgical resection with those of the surgical specimen, to evaluate the potential of the EACSGE classification at the initial diagnostic workup.Methods:A total of 106 EA-EGJA cases with available endoscopic biopsies and matched surgical resection specimens were retrieved from five Italian institutions. Histologic classification was performed on all specimens to identify well-differentiated glandular adenocarcinoma (WD-GAC), poorly differentiated glandular adenocarcinoma (PD-GAC), mucinous muconodular carcinoma (MMC), infiltrative mucinous carcinoma (IMC), diffuse desmoplastic carcinoma, diffuse anaplastic carcinoma (DAC), and mixed subtypes. Related risk subgroups (low-risk versus high-risk) were also assessed. The correlations of histologic classes and risk subgroups between diagnostic biopsies and surgical resection specimens were explored with Spearman’s correlation test. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, true positives, true negatives, false positives, and false negatives were also calculated.Results:A strong positive correlation between biopsies and surgical specimens occurred for both histologic classes (coefficient: 0.75,p< 0.001) and risk subgroups (coefficient: 0.65,p< 0.001). The highest sensitivities and specificities were observed for MMC, IMC, and DAC (100% and 99% for all), followed by WD-GAC (sensitivity 91%, specificity 79%) and PD-GAC (sensitivity 722%, specificity 86%). The low-risk and high-risk groups presented a sensitivity and specificity of 89% and 76% (low-risk) and 76% and 89% (high-risk).Conclusions:The EACSGE histologic classification of EA-EGJAs and associated prognostic subgroups can be reliably assessed on pre-operative diagnostic biopsies. Further studies on larger and more representative cohorts of EA-EGJAs will allow us to validate our findings and confirm if the EA-EGJA biopsy histomorphology and clinical TNM staging will be as efficient as the surgical specimen histomorphology and pTNM in predicting patient prognoses and tailoring personalized therapeutic approaches.
背景与目的：欧洲食管腺癌研究组（EACSGE）近期基于对未经治疗的手术切除标本的研究，提出了一种针对食管-食管胃结合部腺癌（EA-EGJA）的精细化组织学分类体系。该分类结合病理TNM分期，能有效提示预后、分子事件及治疗反应。本研究通过比较手术切除前内镜活检标本与手术标本的组织学分类，评估EACSGE分类体系在初始诊断阶段的应用潜力。 方法：从五家意大利医疗机构共收集106例同时具备内镜活检标本与匹配手术切除标本的EA-EGJA病例。对所有标本进行组织学分类，包括高分化腺癌（WD-GAC）、低分化腺癌（PD-GAC）、黏液结节型癌（MMC）、浸润性黏液癌（IMC）、弥漫性促结缔组织增生型癌、弥漫性间变性癌（DAC）及混合亚型。同时评估相关风险亚组（低风险与高风险）。采用Spearman相关性检验分析诊断性活检与手术切除标本间组织学分类及风险亚组的相关性，并计算敏感性、特异性、准确率、阳性预测值、阴性预测值、真阳性、真阴性、假阳性及假阴性。 结果：活检标本与手术标本在组织学分类（相关系数：0.75，p<0.001）和风险亚组（相关系数：0.65，p<0.001）上均呈现强正相关。MMC、IMC和DAC的敏感性与特异性最高（均为100%和99%），其次为WD-GAC（敏感性91%，特异性79%）和PD-GAC（敏感性72%，特异性86%）。低风险组与高风险组的敏感性/特异性分别为89%/76%（低风险组）和76%/89%（高风险组）。 结论：EA-EGJA的EACSGE组织学分类及相关预后亚组可通过术前诊断性活检进行可靠评估。未来对更大规模、更具代表性的EA-EGJA队列开展进一步研究，将有助于验证本发现，并确认EA-EGJA活检组织形态学结合临床TNM分期在预测患者预后及制定个体化治疗方案方面，是否与手术标本组织形态学结合病理TNM分期具有同等效能。
肿瘤(癌症)患者之家