Guo Yijia, Qu Wang, Liu Yun, Qu Tao, Song Yan, Xu Jianping, Zhang Bo, Huang Jing
Department of Medical Oncology, 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 May;16(9):e70084. doi: 10.1111/1759-7714.70084.
Immune checkpoint inhibitors have revolutionized the treatment strategy of esophageal squamous cell carcinoma (ESCC). The value of ctDNA dynamic changes in ESCC patients treated with immunochemotherapy was not clear.
A retrospective analysis was performed to analyze the association of ctDNA dynamic changes with the treatment efficacy of immunochemotherapy in patients with locally advanced, metastatic, or recurrent ESCC and who received immunochemotherapy at the Department of Medical Oncology, National Cancer Center from June 2023 to December 2024. Tumor mutation burden (TMB) and PD-L1 expression of tumor tissue were also explored.
57 patients with paired ctDNA at baseline and during treatment were analyzed. We found that patients with negative ctDNA during treatment demonstrated a higher tumor regression rate (96.8% vs. 73.1%; p = 0.018) and a higher cCR rate (45.2% vs. 15.4%; p = 0.022). Additionally, patients with continuously negative ctDNA (p = 0.033) or experienced ctDNA clearance during treatment (p = 0.043) had a higher cCR rate compared to those with persistently positive ctDNA. Moreover, among patients with TP53 mutations at baseline, those with TP53 mutations cleared during treatment showed a higher tumor regression rate (88.9% vs. 54.5%; p = 0.031) and cCR rate (33.3% vs. 0%; p = 0.038) compared to patients with persistent TP53 mutations. No correlation was observed between TMB and treatment efficacy, while a higher cCR rate was observed in patients with PD-L1 CPS ≥ 15 (63.6% vs. 24.4%; p = 0.027).
ctDNA dynamic changes demonstrated potential predictive value for the efficacy of immunochemotherapy in patients with ESCC. Further exploration through larger-scale studies is necessary.
免疫检查点抑制剂彻底改变了食管鳞状细胞癌（ESCC）的治疗策略。循环肿瘤DNA（ctDNA）动态变化在接受免疫化疗的ESCC患者中的价值尚不清楚。
进行回顾性分析，以分析2023年6月至2024年12月在国家癌症中心医学肿瘤科接受免疫化疗的局部晚期、转移性或复发性ESCC患者中ctDNA动态变化与免疫化疗疗效的相关性。还探讨了肿瘤组织的肿瘤突变负荷（TMB）和程序性死亡受体配体1（PD-L1）表达。
分析了57例在基线和治疗期间具有配对ctDNA的患者。我们发现，治疗期间ctDNA阴性的患者显示出更高的肿瘤退缩率（96.8%对73.1%；p = 0.018）和更高的完全缓解（cCR）率（45.2%对15.4%；p = 0.022）。此外，与ctDNA持续阳性的患者相比，ctDNA持续阴性（p = 0.033）或在治疗期间经历ctDNA清除（p = 0.043）的患者具有更高的cCR率。此外，在基线时具有TP53突变的患者中，与持续存在TP53突变的患者相比，治疗期间TP53突变清除的患者显示出更高的肿瘤退缩率（88.9%对54.5%；p = 0.031）和cCR率（33.3%对0%；p = 0.038）。未观察到TMB与治疗疗效之间的相关性，而PD-L1联合阳性评分（CPS）≥15的患者中观察到更高的cCR率（63.6%对24.4%；p = 0.027）。
ctDNA动态变化显示出对ESCC患者免疫化疗疗效的潜在预测价值。有必要通过更大规模的研究进行进一步探索。
