Zhang Hai, He Haiquan, Feng Qingyi, Wu Bomeng, Chen Ying, Zhang Zhenyang, Zhou Linrong, Li Cui, Lin Wanli, Lin Jiangbo
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
The Graduate School of Fujian Medical University, Fuzhou, China.
Front Oncol. 2025 Jan 14;14:1463936. doi: 10.3389/fonc.2024.1463936. eCollection 2024.
Neoadjuvant therapy is preferentially recommended for resectable locally advanced esophageal malignancies, with patients who achieve pathological complete response (PCR) anticipated to have longer survival rates. The aim of this study was to compare 3-year follow-up data for patients with esophageal malignancy who achieved PCR through neoadjuvant chemotherapy (nCRT) and to compare the findings with those of neoadjuvant immunotherapy plus chemotherapy (nICT).
This retrospective study included 85 patients with esophageal cancer who underwent surgical resection following nCRT (n=47) or nICT (n=38) between January 1, 2016 and January 1, 2020 at Fujian Medical University Union Hospital and Gaozhou People's Hospital. Propensity score matching was used to match baseline data and reduce bias between the patient groups. Data during the neoadjuvant treatment and perioperative periods were compared, and follow-up was performed to evaluate differences in 3-year survival rate and recurrence-free survival.
After propensity score matching, 28 nCRT patients and 38 nICT patients were included. During neoadjuvant therapy, the nCRT group had higher incidences of leukopenia and neutropenia than did the nICT group. No significant differences were observed in the incidences of hemoglobin decrease, platelet decrease, liver function damage, elevated serum creatinine, diarrhea, radioactive pneumonia or immunotherapy-related pneumonia, and esophageal perforation. The nCRT group had fewer lymph node dissections and lymph node stations. Postoperative lung infection (50.00%) was significantly higher in the nICT group than in the nCRT group (25.00%). The 3-year survival rates were 97.37% and 85.71% in the nICT and nCRT groups, respectively; the 3-year recurrence-free survival rate was significantly lower in the nCRT group (82.14%) than in the nICT group (97.37%, P=0.02).
These findings suggest that patients with esophageal cancer who achieve PCR after nICT treatment may have lower rates of disease recurrence.
新辅助治疗优先推荐用于可切除的局部晚期食管恶性肿瘤，预计达到病理完全缓解（PCR）的患者生存率更高。本研究的目的是比较通过新辅助化疗（nCRT）实现PCR的食管恶性肿瘤患者的3年随访数据，并将结果与新辅助免疫治疗联合化疗（nICT）的患者进行比较。
这项回顾性研究纳入了2016年1月1日至2020年1月1日期间在福建医科大学附属协和医院和高州人民医院接受nCRT（n = 47）或nICT（n = 38）后接受手术切除的85例食管癌患者。采用倾向评分匹配来匹配基线数据并减少患者组之间的偏差。比较新辅助治疗和围手术期的数据，并进行随访以评估3年生存率和无复发生存率的差异。
倾向评分匹配后，纳入28例nCRT患者和38例nICT患者。在新辅助治疗期间，nCRT组白细胞减少和中性粒细胞减少的发生率高于nICT组。在血红蛋白降低、血小板减少、肝功能损害、血清肌酐升高、腹泻、放射性肺炎或免疫治疗相关肺炎以及食管穿孔的发生率方面未观察到显著差异。nCRT组的淋巴结清扫和淋巴结站数较少。nICT组术后肺部感染（50.00%）显著高于nCRT组（25.00%）。nICT组和nCRT组的3年生存率分别为97.37%和85.71%；nCRT组的3年无复发生存率（82.14%）显著低于nICT组（97.37%，P = 0.02）。
这些发现表明，nICT治疗后实现PCR的食管癌患者疾病复发率可能较低。
