Wang Mingxi, Wei Dandan, Cui Zhen, Zhou Yangyang, Yin Chuntong, Zhou Zhengguang, D'Journo Xavier Benoit, Wang Guowen
Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
Department of Gastrointestinal Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, China.
J Thorac Dis. 2025 Mar 31;17(3):1711-1722. doi: 10.21037/jtd-2025-215. Epub 2025 Mar 27.
While neoadjuvant therapy combined with surgery remains standard for locally advanced esophageal squamous cell carcinoma (ESCC), survival outcomes remain suboptimal. Refining multimodal neoadjuvant regimens (including chemoradiotherapy, chemotherapy, and emerging immunotherapy) is critical to improving prognosis. This study sought to evaluate the efficacy and safety of neoadjuvant immuno-chemotherapy in the treatment of locally advanced ESCC, and to examine the correlation between tumor regression grade (TRG) and imaging evaluation.
In total, 106 patients diagnosed with ESCC-only received a 21-day cycle of intravenous camrelizumab plus nab-paclitaxel and carboplatin. The efficacy was evaluated after two cycles, and the patients subsequently underwent tumor resection. All patients completed the full treatment regime and underwent surgery. Patients' treatment response after neoadjuvant therapy, R0 resection rate, TRG, and pathologic complete response (pCR) rate were measured. The adverse events (AEs) were also documented.
The R0 resection (resection with microscopically negative margins) was 97.2% (103/106). The pCR (ypT0N0) rate was 39.6% (42/106), and 50% (53/106) of the patients had a complete response (CR) of the primary tumor but had residual disease in the lymph nodes (ypT0N+). The major pathologic response (MPR) rate was 49% (52/106). Preoperative imaging evaluation of the patients showed that 33% (35/106) had a CR, 34% (36/106) had a partial response (PR), 21.7% (23/106) had stable disease (SD), and 11.3% (12/106) had progressive disease (PD). Based on the postoperative TRG classification, 47.1% (50/106) of the patients had grade 0, 11.3% (12/106) had grade 1, 18% (19/106) had grade 2, and 23.6% (25/106) had grade 3.
This study showed that camrelizumab-based neoadjuvant immuno-chemotherapy was effective in the treatment of locally advanced resectable ESCC. The treatment increased the likelihood of achieving a curative surgical outcome, and the side effects were generally manageable. The treatment warrants further investigation. Moreover, the TRG was found to be significantly associated with imaging assessment; these two approaches can be combined and employed to predict the efficacy of neoadjuvant immuno-chemotherapy.
虽然新辅助治疗联合手术仍是局部晚期食管鳞状细胞癌（ESCC）的标准治疗方案，但生存结果仍不理想。优化多模式新辅助治疗方案（包括放化疗、化疗和新兴的免疫治疗）对于改善预后至关重要。本研究旨在评估新辅助免疫化疗治疗局部晚期ESCC的疗效和安全性，并探讨肿瘤退缩分级（TRG）与影像学评估之间的相关性。
总共106例仅诊断为ESCC的患者接受了为期21天的静脉注射卡瑞利珠单抗联合白蛋白结合型紫杉醇和卡铂的治疗周期。两个周期后评估疗效，随后患者接受肿瘤切除术。所有患者均完成了完整的治疗方案并接受了手术。测量患者新辅助治疗后的治疗反应、R0切除率、TRG和病理完全缓解（pCR）率。还记录了不良事件（AE）。
R0切除（显微镜下切缘阴性的切除）率为97.2%（103/106）。pCR（ypT0N0）率为39.6%（42/106），50%（53/106）的患者原发肿瘤完全缓解（CR）但淋巴结有残留疾病（ypT0N+）。主要病理反应（MPR）率为49%（52/106）。患者术前影像学评估显示，33%（35/106）为CR，34%（36/106）为部分缓解（PR），21.7%（23/106）为疾病稳定（SD），11.3%（12/106）为疾病进展（PD）。根据术后TRG分类，47.1%（50/106）的患者为0级，11.3%（12/106）为1级，18%（19/106）为2级，23.6%（25/106）为3级。
本研究表明，基于卡瑞利珠单抗的新辅助免疫化疗在治疗局部晚期可切除ESCC方面有效。该治疗增加了实现根治性手术结果的可能性，且副作用通常可控。该治疗值得进一步研究。此外，发现TRG与影像学评估显著相关；这两种方法可结合使用以预测新辅助免疫化疗的疗效。
