Li Canjun, Wang Xin, Deng Lei, Wang Jianyang, Zhang Tao, Wang Wenqing, Liu Wenyang, Lv Jima, Feng Qinfu, Zhou Zongmei, Chen Xiankai, Zhang Ruixiang, Qin Jianjun, Li Yin, Bi Nan
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Thorac Cancer. 2025 Apr;16(7):e70054. doi: 10.1111/1759-7714.70054.
Currently, neoadjuvant chemoradiotherapy combined with immunotherapy (NCRI) for patients with locally advanced esophageal squamous cell carcinoma (ESCC) is attracting attention. The purpose of this study was to compare the surgical outcomes and survival between patients receiving NCRI and neoadjuvant chemoradiotherapy (NCRT) followed by surgery.
This study retrospectively included patients with locally advanced ESCC and treated with NCRI or NCRT followed by esophagectomy. Two groups were compared for pathologic complete response (pCR) rate, R0 resection rate, and 3-year recurrence-free survival (RFS). Surgery time, the number of lymph nodes removed, postoperative complications, and 30-day mortality were also compared. Propensity score matching (PSM) was performed to minimize the potential impact of confounding factors.
After PSM, patients in the NCRI group showed a significantly higher pCR rate compared with those in the NCRT group (54.2% vs. 27.1%, p = 0.046). R0 resection rate (100% vs. 89.6%, p = 0.251), surgery time (p = 0.614), the number of lymph nodes removed (p = 0.526), the incidence of total postoperative complications (46.4% vs. 37.9%, p = 0.564) and 30-day mortality (3.6% vs. 1.1%, p = 0.983) were comparable between the two groups. The NCRI group exhibited a significantly higher 3-year RFS rate compared to the NCRT group (79.2% vs. 62.5%, p = 0.032).
For patients with locally advanced ESCC, NCRI showed a significantly higher pCR rate than conventional NCRT, without increased operative risk. NCRI followed by surgery exhibited a superior RFS compared to NCRT followed by surgery. Prospective studies are needed in the future.
目前，新辅助放化疗联合免疫治疗（NCRI）用于局部晚期食管鳞状细胞癌（ESCC）患者正受到关注。本研究的目的是比较接受NCRI和新辅助放化疗（NCRT）后手术的患者的手术结果和生存率。
本研究回顾性纳入了局部晚期ESCC患者，接受NCRI或NCRT后行食管切除术。比较两组的病理完全缓解（pCR）率、R0切除率和3年无复发生存率（RFS）。还比较了手术时间、切除的淋巴结数量、术后并发症和30天死亡率。进行倾向评分匹配（PSM）以尽量减少混杂因素的潜在影响。
PSM后，NCRI组患者的pCR率显著高于NCRT组（54.2%对27.1%，p = 0.046）。两组间R0切除率（100%对89.6%，p = 0.251）、手术时间（p = 0.614）、切除的淋巴结数量（p = 0.526）、术后总并发症发生率（46.4%对37.9%，p = 0.564）和30天死亡率（3.6%对1.1%，p = 0.983）相当。NCRI组的3年RFS率显著高于NCRT组（79.2%对62.5%，p = 0.032）。
对于局部晚期ESCC患者，NCRI的pCR率显著高于传统NCRT，且手术风险未增加。NCRI后手术的RFS优于NCRT后手术。未来需要进行前瞻性研究。
