Zheng Yan, Li Yin, Qin Jianjun, Xing Wenqun, Liu Xianben, Sun Haibo, Chen Xiankai
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
J Thorac Dis. 2019 Oct;11(10):4135-4143. doi: 10.21037/jtd.2019.10.02.
After the first-cycle of neoadjuvant chemotherapy (NAC), many patients with esophageal squamous cell carcinoma (ESCC) experience a stable disease (SD)/progressive disease (PD) response. Clinically, SD patients are recommended to receive a second cycle of NAC, and PD patients are recommended to undergo surgery if possible. However, we found some PD tumors shrank after a second-cycle of NAC. Some first-cycle SD patients may develop PD after second-cycle NAC and lose the chance of surgery. Thus, how to predict the response to second-cycle NAC for first-cycle SD/PD patients is important for clinical practice.
This retrospective single-center study was approved by the Institutional Review Board at the Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital. We retrospectively reviewed patients with ESCC who had NAC and evaluated SD by computed tomography (CT) scan after the first-cycle between March 9, 2013 and October 24, 2016. Univariate and multivariate analyses of the clinical parameters were performed to identify markers predictive of a clinically response by using IBM-SPSS version 23.
There were 64 patients included in the study. Thirty-one first-cycle NAC-SD/PD patients (48.4%) showed a response after second-cycle NAC, which was significantly correlated with alleviated dysphagia (P=0.006) and smoking (P=0.025). In the multivariate analyses, alleviated dysphagia [odds ratio (OR) 3.978; 95% confidence interval (CI), 1.335-11.856; P=0.013] was identified as the only independent predictive factor for tumor response after second-cycle of NAC for first-cycle SD/PD patients.
Alleviated dysphagia might be a useful factor to predict the response to second-cycle NAC for first-cycle SD/PD patients.
在新辅助化疗（NAC）的第一个周期后，许多食管鳞状细胞癌（ESCC）患者出现疾病稳定（SD）/疾病进展（PD）反应。临床上，建议SD患者接受第二个周期的NAC，而PD患者若可能则建议进行手术。然而，我们发现一些PD肿瘤在第二个周期的NAC后缩小。一些第一个周期为SD的患者在第二个周期的NAC后可能会发展为PD并失去手术机会。因此，如何预测第一个周期SD/PD患者对第二个周期NAC的反应对临床实践很重要。
这项回顾性单中心研究已获得郑州大学附属肿瘤医院/河南省肿瘤医院机构审查委员会的批准。我们回顾性分析了2013年3月9日至2016年10月24日期间接受NAC并在第一个周期后通过计算机断层扫描（CT）评估为SD的ESCC患者。使用IBM-SPSS 23版对临床参数进行单因素和多因素分析，以确定预测临床反应的标志物。
该研究共纳入64例患者。31例第一个周期NAC-SD/PD患者（48.4%）在第二个周期的NAC后出现反应，这与吞咽困难缓解（P=0.006）和吸烟（P=0.025）显著相关。在多因素分析中，吞咽困难缓解[比值比（OR）3.978；95%置信区间（CI），1.335-11.856；P=0.013]被确定为第一个周期SD/PD患者第二个周期NAC后肿瘤反应的唯一独立预测因素。
吞咽困难缓解可能是预测第一个周期SD/PD患者对第二个周期NAC反应的有用因素。
