Sui Xizhao, Danzeng Duoji, Ni Ping, Geng Jiayi, Gesang Pingcuo, Zhaxi Renqing, Wei Yuling
Department of Thoracic Surgery, Peking University People's Hospital, China.
Department of Cardio-thoracic Surgery, The Tibet Autonomous Region People's Hospital, China.
Asian J Surg. 2024 Dec 6. doi: 10.1016/j.asjsur.2024.11.134.
Neoadjuvant therapy followed by surgery has been proved to improve the survival of patients with ESCC, and neoadjuvant chemoradiotherapy (nCRT) is the standard of care in most areas of the world. However, multimodality therapy including radiation therapy is actually limited in the current treatment of esophageal cancer in Tibet. The role of neoadjuvant immunotherapy in resectable esophageal cancer has been assessed in multiple phase II clinical trials, but there's lack of evidence of applying neoadjuvant immunotherapy plus chemotherapy in Tibetan residents.
Patients with previously treatment-naïve, resectable ESCC were included in this study. The preoperative treatment regimen included Tislelizumab, nab-paclitaxel and carboplatin. Surgery was planned for every patient who completed neoadjuvant treatment. Surgical approaches and extent of esophageal resection was chosen depended on tumor location.
23 patients with resectable ESCC were included from January 2022 to May 2024 in this study. Among all patients, 5 (21.7 %) had thyroid nodules or dysfunction. 19 of 23 (82.6 %) patients finished 2-3 cycles of treatment. 19 (82.6 %) patients experienced treatment-related adverse events (TRAEs), with 11 (47.8 %) patients experiencing grade 3-4 TRAEs. Thyroid toxicity of grade 1-2 was observed in 12 (52.2 %) patients. The objective response rate (ORR) was 69.6 %, and the disease control rate (DCR) was 100 %.。14 (60.9 %) of 23 patients underwent surgery. All patients underwent R0 resection. The pCR rate was 21.4 %. The median follow-up was 22.4 months. During the follow-up period, there were no recurrences, but 3 patients died due to non-tumor-related causes.
Esophagectomy following neoadjuvant immunotherapy plus chemotherapy appears to be safe and feasible in high altitude natives with resectable esophageal squamous cell carcinoma in Tibet.
新辅助治疗后行手术已被证明可提高食管鳞癌患者的生存率，新辅助放化疗（nCRT）是世界上大多数地区的标准治疗方案。然而，包括放疗在内的多模态治疗在西藏目前的食管癌治疗中实际上是有限的。新辅助免疫治疗在可切除食管癌中的作用已在多项II期临床试验中得到评估，但缺乏在藏族居民中应用新辅助免疫治疗联合化疗的证据。
本研究纳入既往未接受过治疗、可切除的食管鳞癌患者。术前治疗方案包括替雷利珠单抗、白蛋白结合型紫杉醇和卡铂。为每一位完成新辅助治疗的患者计划手术。手术方式和食管切除范围根据肿瘤位置选择。
本研究于2022年1月至2024年5月纳入23例可切除的食管鳞癌患者。在所有患者中，5例（21.7%）有甲状腺结节或功能障碍。23例患者中有19例（82.6%）完成了2 - 3个周期的治疗。19例（82.6%）患者发生治疗相关不良事件（TRAEs），其中11例（47.8%）患者发生3 - 4级TRAEs。12例（52.2%）患者观察到1 - 2级甲状腺毒性。客观缓解率（ORR）为69.6%，疾病控制率（DCR）为100%。23例患者中有14例（60.9%）接受了手术。所有患者均行R0切除。病理完全缓解（pCR）率为21.4%。中位随访时间为22.4个月。随访期间无复发，但3例患者因非肿瘤相关原因死亡。
在西藏可切除食管鳞状细胞癌的高海拔本地人中，新辅助免疫治疗联合化疗后行食管切除术似乎是安全可行的。
