Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Cancer Med. 2024 Aug;13(15):e70113. doi: 10.1002/cam4.70113.
The chemotherapy and immunotherapy combination is currently the primary strategy to treat metastatic esophageal squamous cell carcinoma (ESCC). Neoadjuvant chemoimmunotherapy (NCIT) is being intensively investigated for treating locally advanced ESCC.
We compared the efficacy and safety of NCIT and neoadjuvant chemoradiotherapy (NCRT) to treat locally advanced ESCC.
We included 214 locally advanced ESCC patients who were administered neoadjuvant therapy from May 2014 to April 2022. The patients were grouped according to two neoadjuvant protocols (NCIT and NCRT) routinely used at our institution. Perioperative findings, pathological results, and survival data were compared between the two groups by conducting unmatched and 1:1 propensity score matching (PSM) analyses.
Following 1:1 PSM analysis of the confounders, 66 patients were allocated to each of the two groups. Time span between neoadjuvant therapy completion and esophagectomy was significantly longer after NCRT than that after NCIT (47.1 ± 13.2 days vs. 34.7 ± 8.8 days; p < 0.001). The NCIT group exhibited significantly greater number of harvested lymph nodes than the NCRT group (33.6 ± 12.7 vs. 21.7 ± 10.2; p < 0.001). The pathological complete response and major pathological response rates were similar between the two groups [NCIT group: 25.8% (17/66) and 62.1% (41/66), respectively; NCRT group: 27.3% (18/66) and 56.1% (37/66), respectively (p > 0.05)]. The overall incidence of pneumonia, anastomotic leakage, or postoperative complications did not differ significantly between the two groups. The 2-year cumulative overall survival rates and the 2-year disease-free survival rates of the NCIT and NCRT groups were 80.2% and 62.2%, respectively (p = 0.029) and 70.0% and 50.8%, respectively (p = 0.023).
In locally advanced ESCC patients, short-term survival after NCIT is superior to that after NCRT, with similar perioperative and pathological outcomes.
化疗和免疫治疗的联合应用目前是治疗转移性食管鳞癌（ESCC）的主要策略。新辅助化疗免疫治疗（NCIT）正在被深入研究用于治疗局部晚期 ESCC。
我们比较了 NCIT 和新辅助放化疗（NCRT）治疗局部晚期 ESCC 的疗效和安全性。
我们纳入了 214 例 2014 年 5 月至 2022 年 4 月期间接受新辅助治疗的局部晚期 ESCC 患者。根据我院常规使用的两种新辅助方案（NCIT 和 NCRT）对患者进行分组。通过非匹配和 1:1 倾向评分匹配（PSM）分析比较两组患者的围手术期发现、病理结果和生存数据。
在对混杂因素进行 1:1 PSM 分析后，每组分配 66 例患者。NCRT 组新辅助治疗完成到食管切除术的时间间隔明显长于 NCIT 组（47.1±13.2 天比 34.7±8.8 天；p<0.001）。NCIT 组采集的淋巴结数量明显多于 NCRT 组（33.6±12.7 个比 21.7±10.2 个；p<0.001）。两组的病理完全缓解和主要病理缓解率相似[NCIT 组：25.8%（17/66）和 62.1%（41/66），NCRT 组：27.3%（18/66）和 56.1%（37/66）（p>0.05）]。两组间肺炎、吻合口漏或术后并发症的总发生率无显著差异。NCIT 和 NCRT 组的 2 年累积总生存率和 2 年无病生存率分别为 80.2%和 62.2%（p=0.029）和 70.0%和 50.8%（p=0.023）。
在局部晚期 ESCC 患者中，NCIT 后的短期生存率优于 NCRT，且围手术期和病理结果相似。
