Shen Jianfei, Kong Min, Yang Hong, Jin Ke, Chen Yuping, Fang Wentao, Yu Zhentao, Mao Weimin, Xiang Jiaqing, Han Yongtao, Chen Zhijian, Yang Haihua, Wang Jiaming, Pang Qingsong, Zheng Xiao, Yang Huanjun, Li Tao, Zhang Xu, Li Qun, Wang Geng, Mao Teng, Guo Xufeng, Lin Ting, Liu Mengzhong, Ma Dehua, Ye Minhua, Wang Chunguo, Wang Zheng, Brunelli Alessandro, Cerfolio Robert J, D'Journo Xavier Benoit, Fernando Hiran C, Lordick Florian, Fu Jianhua, Chen Baofu, Zhu Chengchu
Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, China.
Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
Ann Transl Med. 2021 Oct;9(20):1516. doi: 10.21037/atm-21-3331.
Few studies have exclusively investigated the value of pathological complete response (pCR), in esophageal squamous cell carcinoma (ESCC) patients, although it is a clinically significant parameter to evaluate the impact of neoadjuvant chemoradiotherapy (nCRT) on treatment outcome after surgery. The aim of our study was to explore the relationship between pCR after nCRT and survival among patients with local ESCC.
All patients receiving nCRT followed by surgery in NEOCRTEC5010-trial (NCT01216527) were included. Non-pCR patients were classified into three subgroups: ypTanyN0M0, ypT0NanyM0 and ypTanyNanyM0. The Kaplan-Meier method with log-rank test was employed to evaluate disease-free survival (DFS) and overall survival (OS). Multivariate regression analysis was performed using a Cox proportional hazards model to identify clinicopathological parameters associated with pCR.
Among the 185 patients included, 80 (43.2%) achieved pCR after nCRT. The mean survival time of the pCR group was significantly longer than that of the non-pCR group (92.6 69.2 months; HR, 2.70; 95% CI: 1.48-4.92; P=0.001). The 5-year OS and DFS of the pCR group were 79.3% and 77% respectively, compared to 54.8% and 51.2%, respectively, in the non-pCR group. The results showed that the OS and DFS of the ypTanyN0M0 group were better than those of the ypT0NanyM0 group and the ypTanyNanyM0 group. We also found that the number of dissected lymph nodes and pCR were independent risk factors for DFS and OS rates.
pCR after nCRT is an important prognostic indicator of OS and DFS in patients with ESCC. In addition, lymph-node status could represent an important parameter in the prognostic evaluation of esophageal cancer patients.
尽管病理完全缓解（pCR）是评估新辅助放化疗（nCRT）对食管癌患者术后治疗效果影响的一个具有临床意义的参数，但很少有研究专门探讨其在食管鳞状细胞癌（ESCC）患者中的价值。本研究的目的是探讨nCRT后的pCR与局部ESCC患者生存率之间的关系。
纳入NEOCRTEC5010试验（NCT01216527）中所有接受nCRT后行手术的患者。非pCR患者分为三个亚组：ypTanyN0M0、ypT0NanyM0和ypTanyNanyM0。采用Kaplan-Meier法和对数秩检验评估无病生存期（DFS）和总生存期（OS）。使用Cox比例风险模型进行多变量回归分析，以确定与pCR相关的临床病理参数。
在纳入的185例患者中，80例（43.2%）在nCRT后达到pCR。pCR组的平均生存时间明显长于非pCR组（92.6对69.2个月；HR，2.70；95%CI：1.48-4.92；P=0.001）。pCR组的5年OS和DFS分别为79.3%和77%，而非pCR组分别为54.8%和51.2%。结果显示，ypTanyN0M0组的OS和DFS优于ypT0NanyM0组和ypTanyNanyM0组。我们还发现，清扫淋巴结数量和pCR是DFS和OS率的独立危险因素。
nCRT后的pCR是ESCC患者OS和DFS的重要预后指标。此外，淋巴结状态可能是食管癌患者预后评估的一个重要参数。
