局部晚期食管鳞状细胞癌新辅助免疫化疗后的围手术期结局与生存情况

Perioperative outcomes and survival after neoadjuvant immunochemotherapy for locally advanced esophageal squamous cell carcinoma.

作者信息

Yang Xinyu, Yin Hao, Zhang Shaoyuan, Jiang Tian, Gu Jianmin, Jiao Heng, Wang Hao, Liang Fei, Xu Songtao, Fan Hong, Ding Jianyong, Ge Di, Wang Qun, Yin Jun, Tan Lijie

机构信息

Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.

Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Clinical Statistics Center, Zhongshan Hospital, Fudan University, Shanghai, China.

出版信息

J Thorac Cardiovasc Surg. 2025 Jan;169(1):289-300.e6. doi: 10.1016/j.jtcvs.2024.06.020. Epub 2024 Jun 27.

DOI:10.1016/j.jtcvs.2024.06.020

PMID:38944271

Abstract

OBJECTIVE

This study aimed to compare the difference in perioperative outcomes and prognosis between neoadjuvant immunochemotherapy and neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma.

METHODS

The patients with locally advanced esophageal squamous cell carcinoma receiving neoadjuvant immunochemotherapy or neoadjuvant chemoradiotherapy were identified from a prospectively maintained database at Zhongshan Hospital of Fudan University between January 2018 and March 2022. Propensity score matching was performed to balance the 2 groups.

RESULTS

A total of 124 patient pairs were enrolled in the final analysis. The complete pathological response rate (20.2% vs 29.0%, P = .140) was similar in the 2 groups, whereas the lower major pathological response rate (44.4% vs 61.3%, P = .011) was observed in the neoadjuvant immunochemotherapy group. Neoadjuvant immunochemotherapy was associated with a lower rate of adverse events (42.7% vs 55.6%, P = .047) without additional postoperative complications (38.7% vs 35.5%, P = .693). The neoadjuvant immunochemotherapy group had lower distant metastasis (6.5% vs 16.1%, P = .027) and overall recurrence (11.3% vs 23.4%, P = .019) in the postoperative 1 year. Also, neoadjuvant immunochemotherapy was associated with better progression-free survival (hazard ratio, 0.50; 95% CI, 0.32-0.77; P = .002). Cox proportional hazard analysis showed that neoadjuvant immunochemotherapy (univariable: hazard ratio, 0.55; 95% CI, 0.37-0.82; P = .003; multivariable: hazard ratio, 0.44; 95% CI, 0.29-0.65; P < .001) was one of the independent prognostic factors for progression-free survival. The 2 groups had similar overall survival (hazard ratio, 0.62; 95% CI, 0.36-1.09; P = .094) at the latest follow-up.

CONCLUSIONS

This retrospective study showed that neoadjuvant immunochemotherapy was safe and effective for patients with locally advanced esophageal squamous cell carcinoma. Further verification is needed in randomized controlled trials.

摘要

目的

本研究旨在比较新辅助免疫化疗与新辅助放化疗用于局部晚期食管鳞状细胞癌时围手术期结局及预后的差异。

方法

从复旦大学附属中山医院2018年1月至2022年3月前瞻性维护的数据库中，识别接受新辅助免疫化疗或新辅助放化疗的局部晚期食管鳞状细胞癌患者。进行倾向评分匹配以平衡两组。

结果

最终分析纳入了124对患者。两组的完全病理缓解率相似（20.2% 对29.0%，P = 0.140），而新辅助免疫化疗组的主要病理缓解率较低（44.4% 对61.3%，P = 0.011）。新辅助免疫化疗的不良事件发生率较低（42.7% 对55.6%，P = 0.047），且无额外的术后并发症（38.7% 对35.5%，P = 0.693）。新辅助免疫化疗组术后1年远处转移率较低（6.5% 对16.1%，P = 0.027），总复发率较低（11.3% 对23.4%，P = 0.019）。此外，新辅助免疫化疗与更好的无进展生存期相关（风险比，0.50；95%可信区间，0.32 - 0.77；P = 0.002）。Cox比例风险分析显示，新辅助免疫化疗（单变量：风险比，0.55；95%可信区间，0.37 - 0.82；P = 0.003；多变量：风险比，0.44；95%可信区间，0.29 - 0.65；P < 0.001）是无进展生存期的独立预后因素之一。在最新随访时，两组的总生存期相似（风险比，0.62；95%可信区间，0.36 - 1.09；P = 0.094）。