Tan Lingyu, Yang Guozhen, Zeng Chufeng, Zhang Xu
Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Immunol. 2025 Jan 6;15:1502206. doi: 10.3389/fimmu.2024.1502206. eCollection 2024.
Neoadjuvant chemoimmunotherapy (NCIT) has improved pathological complete response and conferred survival benefits in patients with locally advanced esophageal cancer. However, surgical complications unrelated to the tumor continue to detract from patient outcomes. While the "watch-and-wait" strategy has been implemented in clinical complete responders following neoadjuvant therapy for rectal cancer, there is a lack of evidence supporting its practicability in esophageal cancer after NCIT. This pilot case series involves six clinical complete responders who deferred surgery under close surveillance after three or four cycles of neoadjuvant camrelizumab plus chemotherapy and who subsequently received camrelizumab as maintenance treatment. The primary observation measure of the series is event-free survival (EFS). Routine follow-up examinations included endoscopy, biopsy, contrast-enhanced computed tomography, and ultrasonography every 3-6 months. For patients who experienced local recurrence without metastasis, the salvage operation was the priority recommendation. As of September 5, 2024, the average follow-up duration was 124.4 weeks, with the average EFS reaching 134.7 weeks. No deaths or distant metastases were observed. Our findings suggest that responders to NCIT may be spared from esophagectomy. On the prerequisite of sufficient tumor regression during neoadjuvant cycles, immunotherapy may facilitate the continued eradication of residual disease in this series.
新辅助化疗免疫疗法（NCIT）已改善了局部晚期食管癌患者的病理完全缓解情况并带来了生存获益。然而，与肿瘤无关的手术并发症仍然影响患者的预后。虽然“观察等待”策略已在直肠癌新辅助治疗后的临床完全缓解者中实施，但缺乏证据支持其在NCIT后食管癌中的实用性。本前瞻性病例系列纳入了6例临床完全缓解者，他们在接受三或四个周期的新辅助卡瑞利珠单抗联合化疗后，在密切监测下推迟手术，并随后接受卡瑞利珠单抗作为维持治疗。该系列的主要观察指标是无事件生存期（EFS）。常规随访检查包括每3至6个月进行一次内镜检查、活检、增强计算机断层扫描和超声检查。对于出现局部复发但无转移的患者，挽救性手术是优先推荐的治疗方法。截至2024年9月5日，平均随访时间为124.4周，平均EFS达到134.7周。未观察到死亡或远处转移。我们的研究结果表明，NCIT的缓解者可能无需进行食管切除术。在新辅助周期中肿瘤充分退缩的前提下，免疫疗法可能有助于在本系列中持续清除残留疾病。
