白蛋白结合型紫杉醇联合顺铂和卡培他滨新辅助化疗对局部晚期食管鳞状细胞癌的病理完全缓解率令人鼓舞：一项回顾性研究的初步结果
Encouraging Pathological Complete Response Rate from Neoadjuvant Chemotherapy with Albumin-Bound Paclitaxel Plus Cisplatin and Capecitabine for Locally Advanced Esophageal Squamous Carcinoma: Preliminary Outcome of a Retrospective Study.
作者信息
Zhang Wen, Li Yong, Xue Liyan, Qu Dong, Jiang Zhichao, Wang Zhen, Yang Zhaoyang, Zhou Aiping
机构信息
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of 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, People's Republic of China.
出版信息
Cancer Manag Res. 2021 Mar 2;13:2163-2170. doi: 10.2147/CMAR.S298360. eCollection 2021.
OBJECTIVE
To evaluate the efficacy and safety of neoadjuvant chemotherapy with albumin-bound paclitaxel plus cisplatin and capecitabine for locally advanced esophageal squamous cell carcinoma (ESCC).
METHODS
The data of thirty-one patients with locally advanced ESCC (cT1-2N+M0, cT3-4aNanyM0) received preoperative chemotherapy with albumin-bound paclitaxel plus cisplatin and capecitabine (referred as APCC regimen) were retrospectively analysed. The primary endpoint was pathological complete response (pCR) rate.
RESULTS
The median number of chemotherapy cycles with APCC regimen every 3 weeks were 4 (range: 1-6), which was completed by 23 patients. The clinical efficacy of 30 patients was evaluated and all showed reduction of tumours in varying degrees. Five patients received radiotherapy following chemotherapy. Four patients could not receive surgery due to COVID-19 pandemic. Of the 24 patients who underwent surgery, 3 received radiotherapy following chemotherapy, the resection rate of R0 was 95.8%, 9 cases (37.5%) showed pCR and 16 cases (66.7%) showed major pathological response (MPR). Postoperative pathology of 15 cases (62.5%) were stage I (ypT0-2N0M0). Of the 21 patients who underwent surgery after neoadjuvant chemotherapy alone, 8 (38.1%) had pCR and 15 (71.4%) had MPR. The most common grade 3/4 adverse events of chemotherapy included neutropenia (35.5%) and leukopenia (9.7%). Grade 2 postoperative complications occurred in 3 (12.5%) patients.
CONCLUSION
The preliminary results of this study suggest that preoperative chemotherapy with the triplet regimen of albumin-bound paclitaxel, cisplatin and capecitabine for patients with locally advanced ESCC revealed significant tumour downstage and encouraging pCR rate, with well-tolerable toxicities. The role of this regimen warrants further investigation.
目的
评估白蛋白结合型紫杉醇联合顺铂和卡培他滨新辅助化疗治疗局部晚期食管鳞状细胞癌（ESCC）的疗效和安全性。
方法
回顾性分析31例局部晚期ESCC（cT1 - 2N + M0，cT3 - 4aNanyM0）患者接受白蛋白结合型紫杉醇联合顺铂和卡培他滨术前化疗（称为APCC方案）的数据。主要终点为病理完全缓解（pCR）率。
结果
每3周进行的APCC方案化疗周期中位数为4（范围：1 - 6），23例患者完成化疗。评估了30例患者的临床疗效，所有患者均显示肿瘤有不同程度缩小。5例患者化疗后接受放疗。4例患者因新冠疫情无法接受手术。在接受手术的24例患者中，3例化疗后接受放疗，R0切除率为95.8%，9例（37.5%）显示pCR，16例（66.7%）显示主要病理反应（MPR）。15例（62.5%）患者术后病理分期为I期（ypT0 - 2N0M0）。在仅接受新辅助化疗后接受手术的21例患者中，8例（38.1%）有pCR，15例（71.4%）有MPR。化疗最常见的3/4级不良事件包括中性粒细胞减少（35.5%）和白细胞减少（9.7%）。3例（12.5%）患者发生2级术后并发症。
结论
本研究的初步结果表明，白蛋白结合型紫杉醇、顺铂和卡培他滨三联方案对局部晚期ESCC患者进行术前化疗可使肿瘤显著降期，pCR率令人鼓舞，且毒性耐受性良好。该方案的作用值得进一步研究。
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