Jin Ke, Chen Baofu, Wang Chunguo, Zhang Bo, Zhang Jian, Kong Min, Wang Linyao, Zhu Chengchu, Shen Jianfei
Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou, China.
Ann Transl Med. 2021 Apr;9(8):660. doi: 10.21037/atm-21-458.
There are few studies focused on comparing the toxicity, postoperative complication rate, and survival among patients with locally advanced esophageal squamous cell cancer receiving a different dose and intensity of vinorelbine plus cisplatin for neoadjuvant chemoradiotherapy (nCRT) followed by surgery.
In total, 78 patients diagnosed with locally advanced esophageal squamous cell cancer that had received a vinorelbine and cisplatin (VP)1 or VP2 regimen for nCRT followed by surgery in Taizhou Hospital of Zhejiang Province between June 2008 and December 2016 were retrospectively analyzed. The VP1 regimen involved cisplatin 75 mg/m on day 1, and vinorelbine 25 mg/m on days 1 and 8, for two cycles. The VP2 regimen involved cisplatin 25 mg/m on days 1 to 4, and vinorelbine 25 mg/m on days 1 and 8, for two cycles. The rate of adverse events, postoperative complications, and survival were compared between the two groups.
The median overall survival (OS) was 97.6 months (85.6-109.7) in the VP2 group, which was not significantly different to that of the VP1 group [hazard ratio (HR), 1.008 (0.999-1.108); P=0.509]. The main toxicity was hematologic adverse events. The VP2 group had significantly higher rates of all grades of anemia, leukopenia, neutropenia, and thrombocytopenia (all P<0.05), as well as grade 3 or 4 of leukopenia and neutropenia (P<0.05) compared to the VP1 group. Regarding postoperative complications, the VP2 group had a significantly higher rate of pulmonary infection than the VP1 group (P<0.05).
Compared with VP2, VP1 showed comparable efficacy in terms of survival, with less hematologic toxicity and postoperative pulmonary infection. Therefore, we recommended that VP1 over VP2 to be the optimized VP neoadjuvant chemotherapy regimen for locally advanced esophageal squamous cell cancer.
很少有研究聚焦于比较接受不同剂量和强度的长春瑞滨联合顺铂进行新辅助放化疗（nCRT）后手术的局部晚期食管鳞状细胞癌患者的毒性、术后并发症发生率及生存率。
回顾性分析2008年6月至2016年12月在浙江省台州医院接受长春瑞滨和顺铂（VP）1或VP2方案进行nCRT后手术的78例诊断为局部晚期食管鳞状细胞癌的患者。VP1方案为第1天给予顺铂75mg/m²，第1天和第8天给予长春瑞滨25mg/m²，共两个周期。VP2方案为第1至4天给予顺铂25mg/m²，第1天和第8天给予长春瑞滨25mg/m²，共两个周期。比较两组的不良事件发生率、术后并发症及生存率。
VP2组的中位总生存期（OS）为97.6个月（85.6 - 109.7），与VP1组无显著差异[风险比（HR），1.008（0.999 - 1.108）；P = 0.509]。主要毒性为血液学不良事件。与VP1组相比，VP2组所有级别的贫血、白细胞减少、中性粒细胞减少和血小板减少的发生率均显著更高（均P < 0.05），以及3或4级白细胞减少和中性粒细胞减少（P < 0.05）。关于术后并发症，VP2组的肺部感染发生率显著高于VP1组（P < 0.05）。
与VP2相比，VP1在生存率方面显示出相当的疗效，血液学毒性和术后肺部感染较少。因此，我们推荐VP1优于VP2作为局部晚期食管鳞状细胞癌的优化VP新辅助化疗方案。
