Huang Jin, Chen Chao, Shen Yan-Ming, Luo Yun-Fan, Sun Zhao-Min, Chen Jie, Xu Shao-Jun, Lin Ji-Hong, Chen Shu-Chen
Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China.
Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
BMC Gastroenterol. 2025 May 8;25(1):344. doi: 10.1186/s12876-025-03959-z.
The utility of the immune prognostic index (IPI) for esophageal squamous cell carcinoma (ESCC) has yet to be established after minimally invasive esophagectomy (MIE). The purpose of this study was to investigate the value of IPI in predicting the prognosis and postoperative adjuvant chemotherapy (AC) benefits of ESCC patients.
Between January 2011 and December 2018, 613 ESCC patients underwent MIE at our center and were divided into two groups: low IPI and high IPI.Log-rank tests were used to compare the overall survival (OS) and disease-free survival (DFS) of patients in different groups based on Kaplan-Meier survival analysis. Differences in clinical characteristics between groups were eliminated by propensity score matching (PSM) analysis. To identify independent risk factors influencing OS and DFS, the Cox proportional risk model was used.
In comparison to the high IPI group, the low IPI group had a better 5-year OS and DFS in both the entire and matched cohorts (P < 0.05). IPI was found to be an independent prognostic factor for OS and DFS in a multivariate analysis of the entire cohort and the matched cohort (P < 0.05). In subgroup analyses of most clinicopathological factors, high IPI was associated with a higher risk of death or recurrence in the matched cohorts. When combined with 8th TNM staging, the 5-year OS and DFS of stage II or III patients with low IPI in the AC group were not different from those in the non-AC group (P > 0.05), and AC of stage III patients with high IPI significantly prolonged 5-year OS and DFS (OS: 37.4% vs 26.2%, P = 0.018; DFS: 33.6% vs 19.8%, P = 0.042).
Preoperative IPI is a promising predictor of ESCC after MIE. For stage III ESCC patients with high IPI, AC can significantly reduce the risk of death or recurrence.
微创食管切除术后（MIE），免疫预后指数（IPI）在食管鳞状细胞癌（ESCC）中的应用价值尚未明确。本研究旨在探讨IPI在预测ESCC患者预后及术后辅助化疗（AC）获益方面的价值。
2011年1月至2018年12月期间，613例ESCC患者在本中心接受了MIE手术，并分为两组：低IPI组和高IPI组。基于Kaplan-Meier生存分析，采用对数秩检验比较不同组患者的总生存期（OS）和无病生存期（DFS）。通过倾向评分匹配（PSM）分析消除组间临床特征的差异。为确定影响OS和DFS的独立危险因素，使用Cox比例风险模型。
与高IPI组相比，低IPI组在整个队列和匹配队列中的5年OS和DFS均更好（P<0.05）。在整个队列和匹配队列的多因素分析中，IPI被发现是OS和DFS的独立预后因素（P<0.05）。在大多数临床病理因素的亚组分析中，高IPI与匹配队列中更高死亡或复发风险相关。当与第8版TNM分期相结合时，AC组中低IPI的II期或III期患者的5年OS和DFS与非AC组无差异（P>0.05），而高IPI的III期患者的AC显著延长了5年OS和DFS（OS：37.4%对26.2%，P=0.018；DFS：33.6%对19.8%，P=0.042）。
术前IPI是MIE术后ESCC的一个有前景的预后指标。对于高IPI的III期ESCC患者，AC可显著降低死亡或复发风险。
