Tasoudis Panagiotis, Manaki Vasiliki, Iwai Yoshiko, Buckeridge Steven A, Khoury Audrey L, Agala Chris B, Haithcock Benjamin E, Mody Gita N, Long Jason M
Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Cancers (Basel). 2024 Jul 4;16(13):2460. doi: 10.3390/cancers16132460.
The current National Comprehensive Cancer Network advises neoadjuvant chemoradiotherapy followed by surgery for locally advanced cases of esophageal cancer. The role of immunotherapy in this context is under heavy investigation.
Patients with esophageal adenocarcinoma were identified in the National Cancer Database (NCDB) from 2004 to 2019. Three groups were generated as follows: (a) no immunotherapy, (b) neoadjuvant immunotherapy, and (c) adjuvant immunotherapy. Overall survival was evaluated using the Kaplan-Meier method and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality.
Of the total 14,244 patients diagnosed with esophageal adenocarcinoma who received neoadjuvant chemoradiation, 14,065 patients did not receive immunotherapy, 110 received neoadjuvant immunotherapy, and 69 received adjuvant immunotherapy. When adjusting for established risk factors, adjuvant immunotherapy was associated with significantly improved survival compared to no immunotherapy and neoadjuvant immunotherapy during a median follow-up period of 35.2 months. No difference was noted among patients who received no immunotherapy vs. neoadjuvant immunotherapy in the same model.
In this retrospective analysis of the NCDB, receiving adjuvant immunotherapy offered a significant survival advantage compared to no immunotherapy and neoadjuvant immunotherapy in the treatment of esophageal adenocarcinoma. The addition of neoadjuvant immunotherapy to patients treated with neoadjuvant chemoradiation did not improve survival in this cohort. Further studies are warranted to investigate the long-term outcomes of immunotherapy in esophageal cancer.
当前美国国立综合癌症网络建议对局部晚期食管癌患者先进行新辅助放化疗，然后进行手术。免疫疗法在这种情况下的作用正在深入研究中。
从2004年至2019年的美国国家癌症数据库（NCDB）中识别出食管腺癌患者。分为以下三组：（a）未接受免疫疗法，（b）新辅助免疫疗法，（c）辅助免疫疗法。使用Kaplan-Meier方法和Cox比例风险分析评估总生存期，并对先前描述的死亡风险因素进行校正。
在总共14244例接受新辅助放化疗的食管腺癌患者中，14065例未接受免疫疗法，110例接受新辅助免疫疗法，69例接受辅助免疫疗法。在校正既定风险因素后，在35.2个月的中位随访期内，辅助免疫疗法与未接受免疫疗法和新辅助免疫疗法相比，生存期显著改善。在同一模型中，未接受免疫疗法与新辅助免疫疗法的患者之间未观察到差异。
在对NCDB的这项回顾性分析中，与未接受免疫疗法和新辅助免疫疗法相比，接受辅助免疫疗法在食管腺癌治疗中具有显著的生存优势。在接受新辅助放化疗的患者中添加新辅助免疫疗法并未改善该队列的生存期。有必要进一步研究以调查免疫疗法在食管癌中的长期疗效。
