Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
World J Surg Oncol. 2024 Nov 1;22(1):288. doi: 10.1186/s12957-024-03570-8.
The current treatment strategies for borderline resectable esophageal squamous cell carcinoma remain controversial. This study aimed to evaluate the efficacy and safety of programmed cell death 1 inhibitors combined with chemotherapy, followed by conversion surgery, for borderline resectable esophageal squamous cell carcinoma.
Patients with borderline resectable esophageal squamous cell carcinoma treated with induction immunochemotherapy from January 1, 2020 to July 1, 2023 at our hospital were retrospectively analyzed. The primary study outcome was the R0 resection rate. Secondary study outcomes included progression-free survival (PFS), overall survival (OS), pathological complete remission (pCR) rate, and safety.
Forty patients with borderline resectable esophageal squamous cell carcinoma were included in the analysis. The R0 resection rate was 23/40 (57.5%); the conversion success rate was 27/40 (67.5%), and the pCR rate was 11/40 (27.5%). The median follow-up was 23.6 months (95% CI, 19.1-28.2). One-year OS and PFS rates were 77.7% and 71.8%, respectively. The incidence rate of Grade 3-4 adverse events was 10%. There was a significant difference in PFS between patients who underwent surgery and those who did not (P = 0.008, HR: 0.144 95%CI: 0.034-0.606). However, the difference in OS was not significant (P = 0.128, HR: 0.299 95%CI: 0.063-1.416). Patients who achieved clinical downstaging after induction therapy had significantly better OS (P = 0.004 h: 0.110 95%CI: 0.025-0.495) and PFS (P = 0.0016, HR: 0.106 95%CI: 0.026-0.426) compared to those who did not.
Conversion surgery after induction immunochemotherapy is a promising new strategy with a high conversion rate, inspiring R0 resection rate, significant pathological remission rate, and mild toxicity for borderline resectable esophageal squamous cell carcinoma.
目前对于局部可切除食管鳞癌的治疗策略仍存在争议。本研究旨在评估程序性细胞死亡 1 抑制剂联合化疗后行转化手术治疗局部可切除食管鳞癌的疗效和安全性。
回顾性分析 2020 年 1 月 1 日至 2023 年 7 月 1 日我院收治的行诱导免疫化疗的局部可切除食管鳞癌患者。主要研究终点为 R0 切除率。次要研究终点包括无进展生存期（PFS）、总生存期（OS）、病理完全缓解率（pCR）和安全性。
共纳入 40 例局部可切除食管鳞癌患者。R0 切除率为 23/40（57.5%）；转化手术成功率为 27/40（67.5%），pCR 率为 11/40（27.5%）。中位随访时间为 23.6 个月（95%CI，19.1-28.2）。1 年 OS 和 PFS 率分别为 77.7%和 71.8%。3-4 级不良事件发生率为 10%。行手术治疗与未行手术治疗患者的 PFS 差异有统计学意义（P=0.008，HR：0.144，95%CI：0.034-0.606）。但 OS 差异无统计学意义（P=0.128，HR：0.299，95%CI：0.063-1.416）。诱导治疗后获得临床降期的患者 OS（P=0.004，HR：0.110，95%CI：0.025-0.495）和 PFS（P=0.0016，HR：0.106，95%CI：0.026-0.426）明显优于未获得临床降期的患者。
诱导免疫化疗后行转化手术是一种很有前途的新策略，具有较高的转化率、令人鼓舞的 R0 切除率、显著的病理缓解率和轻度毒性，适用于局部可切除食管鳞癌。
