Yu Yong-Kui, Meng Fan-Yu, Wei Xiu-Feng, Chen Xian-Kai, Li Hao-Miao, Liu Qi, Li Can-Jun, Xie Hou-Nai, Xu Lei, Zhang Rui-Xiang, Xing Wenqun, Li Yin
Section of Esophageal and Mediastinal Oncology, 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, China; The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan Province, China.
Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China.
J Thorac Cardiovasc Surg. 2024 Aug;168(2):417-428.e3. doi: 10.1016/j.jtcvs.2023.12.030. Epub 2024 Jan 19.
To date, few studies have compared effectiveness and survival rates of neoadjuvant chemotherapy combined with immunotherapy (NACI) and conventional neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced esophageal squamous cell carcinoma (ESCC). The present study was conducted to compare therapeutic response and survival between NACI and NCRT.
The study cohort comprised patients with locally advanced ESCC treated with either NACI or NCRT followed by surgery between June 2018 and March 2021. The 2 groups were compared for treatment response, 3-year overall survival (OS), and disease-free survival (DFS). Survival curves were created using the Kaplan-Meier method, differences were compared using the log-rank test, and potential imbalances were corrected for using the inverse probability of treatment weighting (IPTW) method.
Among 202 patients with locally advanced ESCC, 81 received NACI and 121 received conventional NCRT. After IPTW adjustment, the R0 resection rate (85.2% vs 92.3%; P = .227) and the pathologic complete response (pCR) rate (27.5% vs 36.4%; P = .239) were comparable between the 2 groups. Nevertheless, patients who received NACI exhibited both a better 3-year OS rate (91.7% vs 79.8%; P = .032) and a better 3-year DFS rate (87.4% vs 72.8%; P = .039) compared with NCRT recipients.
NACI has R0 resection and pCR rates comparable to those of NCRT and seems to be correlated with better prognosis than NCRT. NACI followed by surgery may be an effective treatment strategy for locally advanced ESCC.
迄今为止，很少有研究比较新辅助化疗联合免疫疗法（NACI）与传统新辅助放化疗（NCRT）对局部晚期食管鳞状细胞癌（ESCC）患者的疗效和生存率。本研究旨在比较NACI和NCRT的治疗反应和生存率。
研究队列包括2018年6月至2021年3月期间接受NACI或NCRT治疗后行手术的局部晚期ESCC患者。比较两组的治疗反应、3年总生存率（OS）和无病生存率（DFS）。采用Kaplan-Meier法绘制生存曲线，用对数秩检验比较差异，并采用治疗权重逆概率（IPTW）法校正潜在的不平衡。
在202例局部晚期ESCC患者中，81例接受了NACI，121例接受了传统NCRT。经IPTW调整后，两组的R0切除率（85.2%对92.3%；P = 0.227）和病理完全缓解（pCR）率（27.5%对36.4%；P = 0.239）相当。然而，与接受NCRT的患者相比，接受NACI的患者3年OS率（91.7%对79.8%；P = 0.032）和3年DFS率（87.4%对72.8%；P = 0.039）均更好。
NACI的R0切除率和pCR率与NCRT相当，且似乎比NCRT预后更好。NACI后行手术可能是局部晚期ESCC的一种有效治疗策略。
