Li Xiuxiu, Fan Fan, Zhang Ti
Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Key Laboratory of Digestive Cancer Tianjin 300060, China.
Department of Gastroenterology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University Taiyuan 030001, Shanxi, China.
Am J Cancer Res. 2025 Mar 15;15(3):1321-1334. doi: 10.62347/GBOQ6704. eCollection 2025.
Advanced esophageal cancer presents significant treatment challenges, especially after immunochemotherapy failure. This study evaluates the efficacy of further treatment with combination chemotherapy versus combination immunotherapy crossover in terms of tumor regression, quality of life, and identifies factors influencing treatment outcomes.
In a retrospective case-control study, clinical data from 293 patients with advanced esophageal cancer treated at Shanxi Province Cancer Hospital between February 2021 and February 2023 were analyzed. Patients excluded from radical resection due to failure of first-line immunotherapy were divided into two groups: 95 received combination chemotherapy with Irinotecan and Tigio (S-1, Tegafur/Gimeracil/Oteracil Potassium), and 198 underwent Anlotinib targeted therapy combined with immunotherapy crossover. Treatment efficacy was assessed using tumor regression grading (TRG), and quality of life was evaluated using EORTC QLQ-C30 and QLQ-OES18 scales. Potential factors affecting treatment efficacy were examined using multivariate logistic regression analysis.
Baseline characteristics, including age, gender, body mass index (BMI), and history of smoking and alcohol consumption, were comparable between the two groups. TRG showed no significant differences in distribution, with objective response rates of 40% in the Irinotecan/S-1 group and 44.44% in the combined immunotherapy crossover group (P = 0.472). However, quality of life measures indicated superior outcomes from immunotherapy crossover in physical (P = 0.024), emotional (P = 0.002), and general health scores (P = 0.003). Factors negatively impacting treatment success included male gender, smoking, alcohol consumption history, and certain tumor locations. Elevated CEA levels positively correlated with treatment efficacy. Logistic regression analysis identified male gender (OR, 2.109; P = 0.021), smoking (OR, 2.575; P = 0.003), alcohol consumption (OR, 1.995; P = 0.043), and CEA levels (OR, 0.742; P = 0.017) as significant predictors of treatment efficacy.
Immunotherapy combined with targeted therapy and chemotherapy alone showed comparable efficacy in tumor regression. However, immunotherapy combined with targeted therapy improved certain aspects of quality of life. Factors such as gender, lifestyle habits, and CEA levels can significantly influence treatment outcomes.
晚期食管癌带来了重大的治疗挑战，尤其是在免疫化疗失败之后。本研究从肿瘤消退、生活质量方面评估了联合化疗与联合免疫治疗交叉序贯进一步治疗的疗效，并确定了影响治疗结果的因素。
在一项回顾性病例对照研究中，分析了2021年2月至2023年2月期间在山西省肿瘤医院接受治疗的293例晚期食管癌患者的临床数据。因一线免疫治疗失败而被排除根治性切除的患者被分为两组：95例接受伊立替康和替吉奥（S-1，替加氟/吉美嘧啶/奥替拉西钾）联合化疗，198例接受安罗替尼靶向治疗联合免疫治疗交叉序贯。使用肿瘤消退分级（TRG）评估治疗疗效，使用欧洲癌症研究与治疗组织QLQ-C30和QLQ-OES18量表评估生活质量。使用多因素逻辑回归分析检查影响治疗疗效的潜在因素。
两组之间的基线特征，包括年龄、性别、体重指数（BMI）以及吸烟和饮酒史，具有可比性。TRG分布无显著差异，伊立替康/S-1组的客观缓解率为40%，联合免疫治疗交叉序贯组为44.44%（P = 0.472）。然而，生活质量测量表明，免疫治疗交叉序贯在身体（P = 0.024）、情感（P = 0.002）和总体健康评分（P = 0.003）方面有更好的结果。对治疗成功产生负面影响的因素包括男性、吸烟、饮酒史和某些肿瘤部位。CEA水平升高与治疗疗效呈正相关。逻辑回归分析确定男性（OR，2.109；P = 0.021）、吸烟（OR，2.575；P = 0.003）、饮酒（OR，1.995；P = 0.043）和CEA水平（OR，0.742；P = 0.017）是治疗疗效的显著预测因素。
免疫治疗联合靶向治疗与单纯化疗在肿瘤消退方面显示出相当的疗效。然而，免疫治疗联合靶向治疗改善了生活质量的某些方面。性别、生活习惯和CEA水平等因素可显著影响治疗结果。
