Zhang Qian, Zhang Tao, Gu Jiaqi, Zhang Xuemei, Mao Yuxin, Zhu Yingying, Zhang Jin, Wang Jingyi, Chen Shuyang, Cao Yang, Wang Muhong, Wang Chunbo
Thoracic Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, China.
The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
Front Immunol. 2025 Feb 24;16:1548520. doi: 10.3389/fimmu.2025.1548520. eCollection 2025.
The aim of this study was to investigate the survival benefits of postoperative radiotherapy (PORT) in patients with resectable esophageal cancer (EC) after neoadjuvant therapy in the Immunotherapy era.
The study was designed as a retrospective cohort study, which included a total of 733 patients with EC from the SEER database and a single-center cohort. We used propensity score matching (PSM) to equilibrate patient characteristics. The investigation incorporated Kaplan-Meier survival analysis and the Cox proportional risk regression model to assess outcomes.
PORT did not significantly improve survival in the overall cohort, with a median overall survival of 38 months (p=0.56) in the SEER cohort and 39 months (p=0.75) in the Chinese cohort. However, in the immunotherapy subgroup, the Chinese cohort demonstrated that immunotherapy combined with PORT significantly improved survival (p=0.044).Multivariate Cox regression analysis demonstrated that patients aged 50-59 years (HR=5.93, 95% CI: 1.67-21.06) and those aged ≥70 years (HR=10.96, 95% CI:3.04-39.56) had increased survival risks compared to patients aged <50 years. Additionally, ypT3-4 stage patients exhibited a higher risk than those with ypT1-2 stage (HR=2.12, 95% CI: 1.14-3.93, p=0.017).Similar trends were observed in cT3-4 staging, R1/R2 and no immunotherapy. Lymph node metastasis also showed a progressive relationship with survival risk, with patients categorized as ypN1 (HR=1.90), ypN2 (HR=4.24), and ypN3 (HR=6.68) experiencing increasingly higher risks (p<0.05).
The collaborative effect of immunotherapy and PORT potentially enhances survival outcomes for patients with EC. However, further prospective research is essential to confirm our results.
本研究旨在探讨免疫治疗时代新辅助治疗后可切除食管癌（EC）患者术后放疗（PORT）的生存获益。
本研究设计为一项回顾性队列研究，共纳入来自监测、流行病学和最终结果（SEER）数据库的733例EC患者以及一个单中心队列。我们使用倾向评分匹配（PSM）来平衡患者特征。研究采用Kaplan-Meier生存分析和Cox比例风险回归模型来评估结果。
PORT在整个队列中未显著改善生存，SEER队列的中位总生存期为38个月（p=0.56），中国队列的中位总生存期为39个月（p=0.75）。然而，在免疫治疗亚组中，中国队列表明免疫治疗联合PORT显著改善了生存（p=0.044）。多因素Cox回归分析表明，与年龄<50岁的患者相比，50-59岁的患者（HR=5.93，95%CI：1.67-21.06）和≥70岁的患者（HR=10.96，95%CI：3.04-39.56）生存风险增加。此外，ypT3-4期患者比ypT1-2期患者表现出更高的风险（HR=2.12，95%CI：1.14-3.93，p=0.017）。在cT3-4分期、R1/R2和未进行免疫治疗中观察到类似趋势。淋巴结转移也与生存风险呈渐进关系，分类为ypN1（HR=1.90）、ypN2（HR=4.24）和ypN3（HR=6.68）的患者风险越来越高（p<0.05）。
免疫治疗和PORT的协同作用可能提高EC患者的生存结局。然而，进一步的前瞻性研究对于证实我们的结果至关重要。
