Zhang Hai, Zhang Zhenyang, Yang Litao, Wu Bomeng, Chen Ying, He Haiquan, Li Cui, Lin Wanli, Lin Jiangbo
The Graduate School of Fujian Medical University, Fuzhou, China.
Department of Thoracic Surgery, Gaozhou People's Hospital, Guangdong Esophageal Cancer Institute Gaozhou Branch, Gaozhou, China.
J Thorac Dis. 2023 Mar 31;15(3):1279-1288. doi: 10.21037/jtd-23-84. Epub 2023 Mar 24.
Neoadjuvant chemoradiotherapy (nCRT) is recommended as the preferred treatment for locally advanced esophageal squamous cell carcinoma. Recent studies have shown that immune checkpoint inhibitors are beneficial in treating advanced esophageal cancer. Therefore, a growing number of clinical centers are conducting trials of neoadjuvant immunotherapy or neoadjuvant immunotherapy plus chemotherapy (nICT) in patients with locally advanced resectable esophageal cancer. Immunocheckpoint inhibitors are expected to play a role in neoadjuvant therapy for esophageal cancer. However, there were few studies comparing nICT with nCRT. This study compared the efficacy and safety of nICT with that of nCRT administered prior to esophagectomy in patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC).
The study included patients with locally advanced resectable ESCC who were scheduled to receive neoadjuvant therapy at Gaozhou People's Hospital from January 1, 2019, to September 1, 2022. The enrolled patients were divided into 2 groups (nCRT or nICT) according to their neoadjuvant therapy regimen. The 2 groups were compared for their baseline data, the incidence of adverse events during neoadjuvant therapy, the clinical evaluation after neoadjuvant therapy, perioperative indicators, and the incidence of postoperative complications and postoperative pathological remission.
A total of 44 patients were enrolled; 23 in the nCRT group and 21 in the nICT group. There were no significant differences between the 2 groups in the baseline data. In the nCRT group, leukopenia occurred more often than in the nICT group, and hemoglobin-decreasing events were rarer (P=0.03<0.05). A significantly higher proportion of patients in the nICT group experienced erythema following neoadjuvant therapy compared to the nCRT group (23.81% 0%; P=0.01<0.05). Neoadjuvant therapy showed no significant difference between the 2 groups for adverse event rates, surgery-related indicators, postoperative pathological remission rates, and postoperative complications.
nICT was a safe and feasible treatment for locally advanced ESCC and it may be a potential new treatment modality.
新辅助放化疗（nCRT）被推荐为局部晚期食管鳞状细胞癌的首选治疗方法。近期研究表明，免疫检查点抑制剂在治疗晚期食管癌方面有益。因此，越来越多的临床中心正在对局部晚期可切除食管癌患者进行新辅助免疫治疗或新辅助免疫治疗联合化疗（nICT）的试验。免疫检查点抑制剂有望在食管癌新辅助治疗中发挥作用。然而，比较nICT与nCRT的研究较少。本研究比较了nICT与nCRT在可切除的局部晚期食管鳞状细胞癌（ESCC）患者食管切除术前的疗效和安全性。
本研究纳入了2019年1月1日至2022年9月1日期间计划在高州人民医院接受新辅助治疗的局部晚期可切除ESCC患者。根据新辅助治疗方案将入选患者分为2组（nCRT或nICT）。比较两组的基线数据、新辅助治疗期间不良事件的发生率、新辅助治疗后的临床评估、围手术期指标以及术后并发症的发生率和术后病理缓解情况。
共纳入44例患者；nCRT组23例，nICT组21例。两组基线数据无显著差异。nCRT组白细胞减少的发生率高于nICT组，血红蛋白降低事件较少见（P = 0.03<0.05）。与nCRT组相比，nICT组新辅助治疗后出现红斑的患者比例显著更高（23.81%对0%；P = 0.01<0.05）。新辅助治疗在两组之间的不良事件发生率、手术相关指标、术后病理缓解率和术后并发症方面无显著差异。
nICT是局部晚期ESCC的一种安全可行的治疗方法，可能是一种潜在的新治疗模式。
