Zhang Guochao, Zhang Chaoqi, Sun Nan, Xue Liyan, Yang Zhaoyang, Fang Lingling, Zhang Zhihui, Luo Yuejun, Gao Shugeng, Xue Qi, Mu Juwei, Gao Yushun, Tan Fengwei, He Jie
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.
Department of Pathology, 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 Cancer Res Clin Oncol. 2022 Apr;148(4):943-954. doi: 10.1007/s00432-021-03659-7. Epub 2021 May 19.
The optimal mode of neoadjuvant treatment for esophageal squamous cell carcinoma (ESCC) has not been well characterized. Our study compared neoadjuvant chemotherapy (NCT) with neoadjuvant chemoradiotherapy (NCRT) for patients with ESCC.
Data from ESCC patients receiving NCRT or NCT combined with esophagectomy between 2010 and 2018 from the National Cancer Center in China were retrospectively collected. Long-term survival, pathological response, and perioperative mortality and morbidity were compared between the NCRT and NCT groups. A Cox proportional hazards model and propensity score matching (PSM) were used to minimize bias due to potential confounding.
Out of 327 eligible patients with ESCC in our study, 90 patients were identified in each group by PSM. The complete pathologic response (pCR) rate in the NCRT group was markedly higher than that in the NCT group (before PSM: 35.1% vs. 6.0%; after PSM: 38.9% vs. 5.6%; both P < 0.001). The rates of 30-day or 90-day mortality were comparable between the two groups, but the NCRT group had a longer postoperative hospital stay (P < 0.001 before PSM and P = 0.012 after PSM) and more postoperative complications (P < 0.001 before PSM and P = 0.014 after PSM), especially, anastomotic leaks (P = 0.001 before PSM and P = 0.013 after PSM). No significant differences in 5-year overall survival (OS) (P = 0.439) or 5-year relapse-free survival (RFS) (P = 0.611) were noted between unmatched groups, but the trend favored NCRT in the propensity score-matched group (77.3% vs. 61.3%; hazard ratio [HR] 1.57; 95% confidence interval [CI] 0.86-2.87; P = 0.141 for OS, and 77.8% vs. 60.5%; HR 1.72; 95% CI 0.95-3.11; P = 0.073 for RFS). Multivariate analysis showed that only ypT and ypN stages were independent predictors of OS before and after PSM (both P < 0.05).
There was no difference in survival between the NCT and NCRT groups, although a trend favored NCRT related to the significantly higher pCR rates. Prospective head-to-head clinical trials to compare these two types of neoadjuvant therapies in ESCC are warranted.
食管鳞状细胞癌（ESCC）新辅助治疗的最佳模式尚未得到充分明确。我们的研究比较了ESCC患者接受新辅助化疗（NCT）与新辅助放化疗（NCRT）的疗效。
回顾性收集2010年至2018年期间在中国国家癌症中心接受NCRT或NCT联合食管切除术的ESCC患者的数据。比较NCRT组和NCT组的长期生存率、病理反应以及围手术期死亡率和发病率。采用Cox比例风险模型和倾向评分匹配（PSM）来尽量减少潜在混杂因素导致的偏差。
在我们研究的327例符合条件的ESCC患者中，通过PSM每组确定了90例患者。NCRT组的完全病理缓解（pCR）率显著高于NCT组（PSM前：35.1%对6.0%；PSM后：38.9%对5.6%；P均<0.001）。两组的30天或90天死亡率相当，但NCRT组术后住院时间更长（PSM前P<0.001，PSM后P=0.012），术后并发症更多（PSM前P<0.001，PSM后P=0.014），尤其是吻合口漏（PSM前P=0.001，PSM后P=0.013）。未匹配组之间的5年总生存率（OS）（P=0.439）或5年无复发生存率（RFS）（P=0.611）无显著差异，但在倾向评分匹配组中趋势有利于NCRT（77.3%对61.3%；风险比[HR]1.57；95%置信区间[CI]0.86-2.87；OS的P=0.141，以及77.8%对60.5%；HR 1.72；95%CI 0.95-3.11；RFS的P=0.073）。多因素分析表明，只有ypT和ypN分期是PSM前后OS的独立预测因素（P均<0.05）。
NCT组和NCRT组的生存率没有差异，尽管趋势有利于NCRT，因为其pCR率显著更高。有必要进行前瞻性的头对头临床试验，以比较ESCC中这两种新辅助治疗方法。
