Liu Yunsong, Men Yu, Bao Yongxing, Ma Zeliang, Wang Jun, Pang Qingsong, Qin Jianjun, Xue Liyan, Hu Chen, Hui Zhouguang
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 VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Radiat Oncol Biol Phys. 2025 Oct 1;123(2):483-494. doi: 10.1016/j.ijrobp.2025.04.020. Epub 2025 May 2.
Neoadjuvant immunochemoradiation therapy (nICRT) is emerging as a promising treatment for resectable esophageal cancer, but comprehensive analyses comparing it with standard neoadjuvant chemoradiation therapy (nCRT) are limited. This meta-analysis aimed to evaluate the efficacy, safety, and survival outcomes of nICRT versus nCRT.
A systematic search of PubMed, Embase, the Cochrane Library, and major conference proceedings up to October 30, 2024, identified studies involving resectable esophageal cancer treated with nICRT or nCRT. Data on pathologic complete response, major pathologic response, treatment-related adverse events, overall survival (OS), and progression-free survival were extracted. A one-stage meta-analysis using reconstructed individual patient data was performed, calculating hazard ratios with 95% CIs.
Thirty-seven studies were included, comprising 811 patients treated with nICRT and 1796 with nCRT. nICRT demonstrated significantly longer OS than nCRT (hazard ratio, 0.714; 95% CI, 0.550-0.926; P = .011). The 1-, 2-, and 3-year OS rates were 89.9%, 76.0% and 66.4%, respectively, for nICRT, compared with 85.0%, 66.5%, and 57.3% for nCRT. The pathologic complete response rate was significantly higher in nICRT (50% vs 38%; P = .040) for squamous cell carcinoma. Safety profiles were comparable, with no significant differences in grades 3 and 4 treatment-related adverse events or postoperative complications between the groups.
nICRT showed potential for superior survival compared with standard nCRT in resectable esophageal cancer and showed enhanced pathologic response in squamous cell carcinoma, with a possibly acceptable safety profile. These findings support future trials integrating immunotherapy into neoadjuvant treatment regimens for esophageal cancer.
新辅助免疫放化疗（nICRT）正成为可切除食管癌的一种有前景的治疗方法，但将其与标准新辅助放化疗（nCRT）进行比较的综合分析有限。本荟萃分析旨在评估nICRT与nCRT的疗效、安全性和生存结果。
对截至2024年10月30日的PubMed、Embase、Cochrane图书馆和主要会议记录进行系统检索，确定了涉及接受nICRT或nCRT治疗的可切除食管癌的研究。提取了病理完全缓解、主要病理缓解、治疗相关不良事件、总生存期（OS）和无进展生存期的数据。使用重建的个体患者数据进行单阶段荟萃分析，计算95%置信区间的风险比。
纳入37项研究，包括811例接受nICRT治疗的患者和1796例接受nCRT治疗的患者。nICRT的OS明显长于nCRT（风险比，0.714；95%置信区间，0.550 - 0.926；P = 0.011）。nICRT的1年、2年和3年OS率分别为89.9%、76.0%和66.4%，而nCRT分别为85.0%、66.5%和57.3%。鳞状细胞癌的nICRT病理完全缓解率显著更高（50%对38%；P = 0.040）。安全性概况相当，两组在3级和4级治疗相关不良事件或术后并发症方面无显著差异。
在可切除食管癌中，nICRT与标准nCRT相比显示出更好的生存潜力，在鳞状细胞癌中显示出更强的病理反应，且安全性概况可能可以接受。这些发现支持未来将免疫疗法纳入食管癌新辅助治疗方案的试验。
