Xie Shu-Han, Yang Li-Tao, Zhang Hai, Tang Zi-Lu, Lin Zhi-Wei, Chen Yi, Hong Zhi-Nuan, Xu Rong-Yu, Lin Wan-Li, Kang Ming-Qiang
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
The Graduate School of Fujian Medical University, Fuzhou, Fujian, China.
Front Immunol. 2024 Feb 5;15:1332492. doi: 10.3389/fimmu.2024.1332492. eCollection 2024.
The need for adjuvant therapy (AT) following neoadjuvant chemoimmunotherapy (nICT) and surgery in esophageal squamous cell cancer (ESCC) remains uncertain. This study aims to investigate whether AT offers additional benefits in terms of recurrence-free survival (RFS) for ESCC patients after nICT and surgery.
Retrospective analysis was conducted between January 2019 and December 2022 from three centers. Eligible patients were divided into two groups: the AT group and the non-AT group. Survival analyses comparing different modalities of AT (including adjuvant chemotherapy and adjuvant chemoimmunotherapy) with non-AT were performed. The primary endpoint was RFS. Propensity score matching(PSM) was used to mitigate inter-group patient heterogeneity. Kaplan-Meier survival curves and Cox regression analysis were employed for recurrence-free survival analysis.
A total of 155 nICT patients were included, with 26 patients experiencing recurrence. According to Cox analysis, receipt of adjuvant therapy emerged as an independent risk factor(HR:2.621, 95%CI:[1.089,6.310], P=0.032), and there was statistically significant difference in the Kaplan-Meier survival curves between non-AT and receipt of AT in matched pairs (p=0.026). Stratified analysis revealed AT bring no survival benefit to patients with pathological complete response(p= 0.149) and residual tumor cell(p=0.062). Subgroup analysis showed no significant difference in recurrence-free survival between non-AT and adjuvant chemoimmunotherapy patients(P=0.108). However, patients receiving adjuvant chemotherapy exhibited poorer recurrence survival compared to non-AT patients (p= 0.016).
In terms of recurrence-free survival for ESCC patients after nICT and surgery, the necessity of adjuvant therapy especially the adjuvant chemotherapy, can be mitigated.
新辅助化疗免疫治疗（nICT）联合手术治疗后，食管鳞状细胞癌（ESCC）患者是否需要辅助治疗（AT）仍不确定。本研究旨在探讨AT对接受nICT和手术治疗的ESCC患者的无复发生存期（RFS）是否有额外益处。
对2019年1月至2022年12月期间来自三个中心的患者进行回顾性分析。符合条件的患者分为两组：AT组和非AT组。对不同AT方式（包括辅助化疗和辅助化疗免疫治疗）与非AT进行生存分析比较。主要终点为RFS。采用倾向评分匹配（PSM）来减轻组间患者异质性。采用Kaplan-Meier生存曲线和Cox回归分析进行无复发生存分析。
共纳入155例接受nICT治疗的患者，其中26例出现复发。根据Cox分析，接受辅助治疗是一个独立的危险因素（HR：2.621，95%CI：[1.089，6.310]，P = 0.032），配对后非AT组和接受AT组的Kaplan-Meier生存曲线有统计学显著差异（p = 0.026）。分层分析显示，AT对病理完全缓解患者（p = 0.149）和残留肿瘤细胞患者（p = 0.062）无生存益处。亚组分析显示，非AT组和辅助化疗免疫治疗患者的无复发生存率无显著差异（P = 0.108）。然而，接受辅助化疗的患者与非AT患者相比，复发生存率较差（p = 0.016）。
对于接受nICT和手术治疗后的ESCC患者，辅助治疗尤其是辅助化疗的必要性可以降低。
