新辅助放化疗与新辅助免疫化疗治疗局部晚期食管鳞癌患者的病理反应和生存结局比较：倾向评分匹配分析。
Comparison of pathologic response and survival outcomes between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant immunochemotherapy (nICT) in patients with locally advanced esophageal squamous cell carcinoma: a propensity score-matched analysis.
机构信息
Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No.55, Section 4, South Renmin Road, Chengdu, 610042, China.
Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Road, Chengdu, 610042, China.
出版信息
BMC Cancer. 2024 Oct 5;24(1):1228. doi: 10.1186/s12885-024-12946-8.
BACKGROUND
In locally advanced, operable esophageal squamous cell carcinoma (ESCC), neoadjuvant immunochemotherapy (nICT) has shown results that are somewhat comparable to those of standard neoadjuvant chemoradiotherapy (nCRT). The impact of these neoadjuvant treatments on survival outcomes, however, has yet to be elucidated.
METHODS
This study included 489 patients with locally advanced ESCC who underwent surgery at Sichuan Cancer Hospital after receiving neoadjuvant treatment between June 2017 and September 2023. Patients were categorized into nCRT and nICT groups based on whether they received neoadjuvant treatment. To mitigate potential biases and balance covariates between the two cohorts, 1:2 propensity score matching (PSM) was conducted using a caliper width of 0.05.
RESULTS
After PSM, the baseline characteristics of the 360 patients remained balanced between the two groups. The findings indicated a superior pathological response in the nCRT group, as evidenced by significantly greater rates of complete response (32.87% vs 14.58%, P < 0.001) and favorable tumor regression grade (TRG), as well as reduced ypT stages and less perineural and angioinvasion, despite comparable ypN stages. Despite the improvement in complete pathological response (pCR) in the nCRT group, the 3-year disease-free survival (DFS) and overall survival (OS) rates did not significantly differ between the groups (DFS: 58.32% vs 56.16%, P = 0.67; OS: 69.96% vs 71.99%, P = 0.99). Crucially, The nICT group showed a lower incidence of grade 3 and 4 adverse events in Leukopenia (2.8% vs 29%; P < 0.001) and Neutropenia (2.8% vs 24%; P < 0.001) during neoadjuvant treatment, comparing with nCRT group.
CONCLUSIONS
Our preliminary findings suggest that nICT followed by surgery offers comparable survival rates to nCRT, despite being less effective in pathologic outcomes. Nonetheless, nICT is a safe and feasible strategy for locally advanced ESCC, warranting further exploration to understand its impact on long-term survival.
背景
在局部晚期可切除的食管鳞状细胞癌（ESCC）中，新辅助免疫化疗（nICT）的结果与标准新辅助放化疗（nCRT）有些相似。然而，这些新辅助治疗对生存结果的影响仍有待阐明。
方法
本研究纳入了 2017 年 6 月至 2023 年 9 月在四川省肿瘤医院接受手术治疗的 489 例局部晚期 ESCC 患者，这些患者在接受新辅助治疗后进行了手术。根据是否接受新辅助治疗，将患者分为 nCRT 组和 nICT 组。为了减轻两组之间潜在的偏倚并平衡协变量，采用卡尺宽度为 0.05 的 1:2 倾向评分匹配（PSM）。
结果
PSM 后，两组 360 名患者的基线特征保持平衡。研究结果表明，nCRT 组的病理缓解更显著，完全缓解率（32.87%比 14.58%，P<0.001）和有利的肿瘤消退分级（TRG）更高，ypT 分期更低，神经周围和血管侵犯更少，尽管 ypN 分期相当。尽管 nCRT 组的完全病理缓解（pCR）有所改善，但两组的 3 年无病生存率（DFS）和总生存率（OS）没有显著差异（DFS：58.32%比 56.16%，P=0.67；OS：69.96%比 71.99%，P=0.99）。重要的是，与 nCRT 组相比，nICT 组在新辅助治疗期间白细胞减少（2.8%比 29%；P<0.001）和中性粒细胞减少（2.8%比 24%；P<0.001）的 3 级和 4 级不良事件发生率较低。
结论
我们的初步研究结果表明，尽管 nICT 在病理结果方面效果较差，但 nICT 联合手术的生存率与 nCRT 相当。然而，nICT 是局部晚期 ESCC 的一种安全可行的策略，值得进一步探索，以了解其对长期生存的影响。
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