Zhang Chi, Xu Fei, Qiang Yong, Cong Zhuang-Zhuang, Wang Qin, Zhang Zheng, Luo Chao, Qiu Bing-Mei, Hu Li-Wen, Shen Yi
Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Cardiothoracic Surgery, Jinling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
Front Surg. 2023 Jan 6;9:1029575. doi: 10.3389/fsurg.2022.1029575. eCollection 2022.
Trimodal therapy (neoadjuvant chemoradiotherapy followed by esophagectomy) for locally advanced esophageal squamous cell carcinoma (ESCC) is associated with a significant survival benefit. Modified Ryan score is an effective tool to evaluated the tumor regression grade (TRG) after neoadjuvant therapy. The aim of this study was to evaluate the prognostic value of TRG for overall survival (OS) and disease-free survival (DFS) in ESCC patients undergoing neoadjuvant chemoradiation.
The study retrospectively reviewed 523 ESCC patients who underwent neoadjuvant chemoradiotherapy and radical esophagectomy at Jinling Hospital from January 2014 to July 2020. Kaplan-Meier curves with log-rank test and Cox regression model were used to evaluate the prognostic factor of TRG based on modified Ryan scoring system on OS and DFS.
After application of inclusion and exclusion criteria, 494 patients with ESCC following neoadjuvant chemoradiotherapy and radical esophagectomy were available for analysis. The TRG scores are significantly associated with smoke history ( = 0.02), lymphovascular invasion (LVI) and/or peripheral nerve invasion (PNI) ( < 0.01), and postoperative adjuvant therapy ( < 0.01). Meanwhile, tumor characteristics including tumor length ( < 0.01) and tumor differentiation grade ( < 0.01) are also significantly associated with TRG score. The results of multivariable Cox regression modal showed that TRG is not an independently prognostic factor for OS ( = 0.922) or DFS ( = 0.526) but tumor length is an independently prognostic factor for DFS ( = 0.046).
This study evaluated the prognostic value of modified Ryan scoring system for ESCC after trimodal therapy and concluded that modified Ryan scoring system can predict survival and recurrence rates but is not an independently prognostic factor for OS and DFS.
对于局部晚期食管鳞状细胞癌（ESCC），三联疗法（新辅助放化疗后行食管切除术）具有显著的生存获益。改良Ryan评分是评估新辅助治疗后肿瘤退缩分级（TRG）的有效工具。本研究旨在评估TRG对接受新辅助放化疗的ESCC患者总生存（OS）和无病生存（DFS）的预后价值。
本研究回顾性分析了2014年1月至2020年7月在金陵医院接受新辅助放化疗及根治性食管切除术的523例ESCC患者。采用Kaplan-Meier曲线结合对数秩检验和Cox回归模型，基于改良Ryan评分系统评估TRG对OS和DFS的预后因素。
应用纳入和排除标准后，494例接受新辅助放化疗及根治性食管切除术的ESCC患者可供分析。TRG评分与吸烟史（P = 0.02）、脉管侵犯（LVI）和/或神经侵犯（PNI）（P < 0.01）以及术后辅助治疗（P < 0.01）显著相关。同时，包括肿瘤长度（P < 0.01）和肿瘤分化程度（P < 0.01）在内的肿瘤特征也与TRG评分显著相关。多变量Cox回归模型结果显示，TRG不是OS（P = 0.922）或DFS（P = 0.526）的独立预后因素，但肿瘤长度是DFS的独立预后因素（P = 0.046）。
本研究评估了改良Ryan评分系统对三联疗法后ESCC的预后价值，得出结论：改良Ryan评分系统可预测生存率和复发率，但不是OS和DFS的独立预后因素。
