Wang X Y, Shen H X, Li R H, Wang J F, Fang M, Tao K Y, Jiang Y H, Ji Y L
Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou310022, China.
Department of Disease Control and Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou310022, China.
Zhonghua Zhong Liu Za Zhi. 2024 Nov 23;46(11):1058-1066. doi: 10.3760/cma.j.cn112152-20240503-00180.
To compare the clinical efficacy of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemo-immunotherapy (nCIT) for locally advanced esophageal squamous cell carcinoma (ESCC). Clinical data of patients who received nCRT or nCIT followed by esophagectomy for locally advanced ESCC between January 2010 and December 2022 were retrospectively collected from Zhejiang Cancer Hospital, with 155 patients in the nCRT group and 470 patients in the nCIT group. Propensity score matching (PSM) was performed in the two groups. After PSM, 120 patients were allocated to the nCRT group and 192 patients to the nCIT group. The pathological response and disease recurrence were compared between the two groups after PSM. Log rank test were used to compare the survival outcomes before and after PSM. Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors for locally advanced ESCC. After PSM, the R0 resection rate in the nCRT group and the nCIT group was 93.3% (112/120) and 93.8% (180/192), respectively, with no statistical significance (=0.884). However, the pathological complete response rate in the nCRT group [36.7% (44/120)] was higher than that in the nCIT group [21.4% (41/192), =0.003]. For patients with R0 resection, the major recurrence pattern was distant metastasis [18.8% (21/112)] in the nCRT group, while the pattern was locoregional recurrence [12.2% (22/180)] in the nCIT group. The 3-year disease-free survival rates were 52.7% and 66.1% (=0.022) and the 3-year overall survival rates were 59.2% and 75.5% (=0.002) in the nCRT and nCIT groups, respectively. Multivariate Cox regression analysis also revealed that the neoadjuvant therapy mode was an independent prognostic factor for patients with locally advanced ESCC. Compared with nCRT, nCIT could significantly prolong disease-free survival (=0.58, 95% : 0.40-0.86) and overall survival (=0.53, 95% : 0.35-0.79). These results suggest that nCIT could significantly improve disease-free survival rate and overall survival rate over nCRT in locally advanced ESCC, even with lower pathological complete response rate.
比较新辅助放化疗（nCRT）和新辅助化疗免疫治疗（nCIT）用于局部晚期食管鳞状细胞癌（ESCC）的临床疗效。回顾性收集2010年1月至2022年12月期间在浙江省肿瘤医院接受nCRT或nCIT治疗后行食管切除术的局部晚期ESCC患者的临床资料，nCRT组155例，nCIT组470例。两组进行倾向评分匹配（PSM）。PSM后，120例患者被分配至nCRT组，192例患者被分配至nCIT组。比较PSM后两组的病理反应和疾病复发情况。采用对数秩检验比较PSM前后的生存结局。进行单因素和多因素Cox回归分析以确定局部晚期ESCC的预后因素。PSM后，nCRT组和nCIT组的R0切除率分别为93.3%（112/120）和93.8%（180/192），差异无统计学意义（=0.884）。然而，nCRT组的病理完全缓解率[36.7%（44/120）]高于nCIT组[21.4%（41/192），=0.003]。对于R0切除的患者，nCRT组的主要复发模式为远处转移[18.8%（21/112）]，而nCIT组的模式为局部区域复发[12.2%（22/180）]。nCRT组和nCIT组的3年无病生存率分别为52.7%和66.1%（=0.022），3年总生存率分别为59.2%和75.5%（=0.002）。多因素Cox回归分析还显示，新辅助治疗模式是局部晚期ESCC患者的独立预后因素。与nCRT相比，nCIT可显著延长无病生存期（=0.58，95%：0.40 - 0.86）和总生存期（=0.53，95%：0.35 - 0.79）。这些结果表明，在局部晚期ESCC中，即使病理完全缓解率较低，nCIT相对于nCRT仍可显著提高无病生存率和总生存率。
