Department of Tumor Integrated Therapy, The Fuzhou First General Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China.
Department of Radiotherapy, The 900th Hospital of the Joint Logistics Team, Fujian Medical University, Fuzhou, Fujian, China.
Medicine (Baltimore). 2023 Aug 25;102(34):e34647. doi: 10.1097/MD.0000000000034647.
The "real world" treatment mode and clinical efficacy of locally advanced esophageal squamous cell carcinoma (LAESCC) are unclear. Meanwhile, the role of immunotherapy in the clinical practice is also puzzling. We conducted the research to investigate the statue of "real world" LAESCC. The clinical data of patients with locally advanced esophageal squamous cell carcinoma which met the criteria from January 2010 to December 2019 have been retrospectively analyzed, and the distribution of clinical treatment patterns has been analyzed. They cover such aspects as dfferences in survival time and further analysis of the differences in overall survival (OS) and progression-free survival (PFS) between patients who received immunotherapy and those who did not receive immunotherapy. What is more, Cox risk regression model has also been used to evaluate the risk factors affecting the prognosis of LAESCC. The cases of a total of 5328 newly diagnosed patients with esophageal cancer were collected, and a total of 363 patients were included in the study, with a median age of (46.2 ± 7.8) years old; 84 (23.1%) and 279 (76.9%) patients received 1L and ≥ 2L, respectively; Concurrent chemoradiotherapy (74.1%) and paclitaxel combined with platinum-based chemotherapy (14.3%) were the main first-line treatment options; fluorouracil combined with cisplatin regimen-based chemotherapy (63.8%) was the main treatment option for ≥ 2L, of which 69 patients (25.3%) received immunization treatment; OS of patients with 1 line of therapy and ≥ 2L were (22.4 ± 7.2) months and (38.7 ± 8.5) months, respectively, and the comparison between groups was statistically significant (P < .05); among 69 patients with ≥ 2L who received immunotherapy, PFS and The OS was (14.6 ± 6.9) and (45.3 ± 9.7) respectively, and the comparison between the groups was statistically significant (all P < .05). Cox multivariate analysis has shown that clinical stage, immunotherapy, concurrent chemoradiotherapy, and ≥ 2L are the main factors affecting OS. and immunotherapy, concurrent chemoradiotherapy, and ≥ 2L are independent factors affecting PFS. Concurrent chemoradiotherapy is currently one of the standard treatments for LAESCC, and most patients are still willing to receive second-line or above treatments. Adding immunotherapy to standard treatment modalities may further optimize clinical treatment modalities and improve patient outcomes.
局部晚期食管鳞状细胞癌（LAESCC）的“真实世界”治疗模式和临床疗效尚不清楚。同时，免疫治疗在临床实践中的作用也令人困惑。我们进行了这项研究，旨在探讨“真实世界”LAESCC 的现状。回顾性分析了 2010 年 1 月至 2019 年 12 月符合标准的局部晚期食管鳞状细胞癌患者的临床资料，并分析了临床治疗模式的分布。涵盖了接受免疫治疗和未接受免疫治疗的患者在生存时间上的差异，以及总生存期（OS）和无进展生存期（PFS）差异的进一步分析。此外，Cox 风险回归模型还用于评估影响 LAESCC 预后的危险因素。共收集了 5328 例新诊断食管癌患者的病例，其中 363 例纳入研究，中位年龄为（46.2±7.8）岁；84 例（23.1%）和 279 例（76.9%）患者分别接受了 1L 和≥2L；同步放化疗（74.1%）和紫杉醇联合铂类化疗（14.3%）是主要的一线治疗选择；氟尿嘧啶联合顺铂方案化疗（63.8%）是≥2L 的主要治疗选择，其中 69 例（25.3%）接受免疫治疗；1 线治疗和≥2L 的患者 OS 分别为（22.4±7.2）个月和（38.7±8.5）个月，两组比较差异有统计学意义（P＜0.05）；在≥2L 接受免疫治疗的 69 例患者中，PFS 和 OS 分别为（14.6±6.9）和（45.3±9.7）个月，两组比较差异有统计学意义（均 P＜0.05）。Cox 多因素分析显示，临床分期、免疫治疗、同步放化疗和≥2L 是影响 OS 的主要因素，而免疫治疗、同步放化疗和≥2L 是影响 PFS 的独立因素。同步放化疗是目前 LAESCC 的标准治疗方法之一，大多数患者仍愿意接受二线或以上的治疗。在标准治疗模式中加入免疫治疗可能进一步优化临床治疗模式，改善患者结局。
