Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road II, Guangzhou, 510080, Guangdong Province, China.
Shenzhen Qianhai Taikang Hospital, Shenzhen, 518000, Guangdong Province, China.
Cancer Immunol Immunother. 2024 Feb 16;73(3):55. doi: 10.1007/s00262-024-03649-x.
For patients with unresectable locally advanced esophageal squamous cell carcinoma (ESCC), concurrent chemoradiotherapy (CCRT) is the current standard treatment; however, the prognosis remains poor. Immunotherapy combined with chemotherapy has demonstrated improved survival outcomes in advanced ESCC. Nevertheless, there is a lack of reports on the role of induction immunotherapy plus chemotherapy prior to CCRT for unresectable locally advanced ESCC. Therefore, this study aimed to evaluate the efficacy and safety of induction immunotherapy plus chemotherapy followed by definitive chemoradiotherapy in patients with unresectable locally advanced ESCC.
This study retrospectively collected clinical data of patients diagnosed with locally advanced ESCC who were treated with radical CCRT between 2017 and 2021 at our institution. The patients were divided into two groups: an induction immunotherapy plus chemotherapy group (induction IC group) or a CCRT group. To assess progression-free survival (PFS) and overall survival (OS), we employed the Kaplan-Meier method after conducting propensity score matching (PSM).
A total of 132 patients with unresectable locally advanced ESCC were included in this study, with 61 (45.26%) patients in the induction IC group and 71 (54.74%) patients in the CCRT group. With a median follow-up of 37.0 months, median PFS and OS were 25.2 and 39.2 months, respectively. The patients in the induction IC group exhibited a significant improvement in PFS and OS in comparison with those in the CCRT group (median PFS: not reached [NR] versus 15.9 months, hazard ratio [HR] 0.526 [95%CI 0.325-0.851], P = 0.0077; median OS: NR versus 25.2 months, HR 0.412 [95%CI 0.236-0.719], P = 0.0012). After PSM (50 pairs), both PFS and OS remained superior in the induction IC group compared to the CCRT group (HR 0.490 [95%CI 0.280-0.858], P = 0.011; HR 0.454 [95%CI 0.246-0.837], P = 0.0093), with 2-year PFS rates of 67.6 and 42.0%, and the 2-year OS rates of 74.6 and 52.0%, respectively. Multivariate analysis revealed that lower tumor stage, concurrent chemotherapy using double agents, and induction immunotherapy plus chemotherapy before CCRT were associated with better prognosis.
Our results showed for the first time that induction immunotherapy plus chemotherapy followed by CCRT for unresectable locally advanced ESCC provided a survival benefit with manageable safety profile. More prospective clinical studies should be warranted.
对于不可切除的局部晚期食管鳞状细胞癌（ESCC）患者，同步放化疗（CCRT）是目前的标准治疗方法；然而，预后仍然较差。免疫治疗联合化疗已显示出在晚期 ESCC 中提高了生存率。然而，对于不可切除的局部晚期 ESCC，在 CCRT 之前进行诱导免疫治疗加化疗的作用尚缺乏报道。因此，本研究旨在评估不可切除的局部晚期 ESCC 患者接受诱导免疫治疗加化疗后再行确定性放化疗的疗效和安全性。
本研究回顾性收集了 2017 年至 2021 年在我院接受根治性 CCRT 治疗的局部晚期 ESCC 患者的临床资料。患者分为两组：诱导免疫治疗加化疗组（诱导 IC 组）或 CCRT 组。采用 Kaplan-Meier 法进行倾向性评分匹配（PSM）后，评估无进展生存期（PFS）和总生存期（OS）。
本研究共纳入 132 例不可切除的局部晚期 ESCC 患者，其中诱导 IC 组 61 例（45.26%），CCRT 组 71 例（54.74%）。中位随访 37.0 个月时，中位 PFS 和 OS 分别为 25.2 和 39.2 个月。与 CCRT 组相比，诱导 IC 组的 PFS 和 OS 均显著改善（中位 PFS：未达到[NR]与 15.9 个月，风险比[HR]0.526[95%CI 0.325-0.851]，P=0.0077；中位 OS：NR 与 25.2 个月，HR 0.412[95%CI 0.236-0.719]，P=0.0012）。PSM（50 对）后，诱导 IC 组的 PFS 和 OS 仍优于 CCRT 组（HR 0.490[95%CI 0.280-0.858]，P=0.011；HR 0.454[95%CI 0.246-0.837]，P=0.0093），2 年 PFS 率分别为 67.6%和 42.0%，2 年 OS 率分别为 74.6%和 52.0%。多因素分析显示，肿瘤分期较低、同步化疗采用双药、CCRT 前诱导免疫治疗加化疗与更好的预后相关。
我们的研究结果首次表明，不可切除的局部晚期 ESCC 患者在 CCRT 前接受诱导免疫治疗加化疗可获得生存获益，并具有可管理的安全性。需要更多的前瞻性临床研究。
