Geng J Y, Mu T, Zhao H, Zhang J W, Chen X Y, Weng W H, Sui X Z, Li Y, Wang X
Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing 100044, China.
Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, China.
Zhonghua Wai Ke Za Zhi. 2025 Jul 1;63(7):597-604. doi: 10.3760/cma.j.cn112139-20241121-00523.
To investigate the impact of the interval between neoadjuvant immunotherapy combined with chemotherapy(nICT) and surgery on pathological outcomes and prognosis in patients. This is a retrospective cohort study. A total of 115 patients with locally advanced esophageal squamous cell carcinoma who underwent nICT followed by sequential surgery at Department of Thoracic Surgery, Peking University People's Hospital or Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University from January 2020 to April 2024 were included. Among them, 99 were male and 16 were female, with an age of ((IQR)) 65 (11) years (range:45 to 81 years). All patients received 2 to 6 cycles of paclitaxel plus platinum-based doublet chemotherapy combined with PD-1 immune checkpoint inhibitors. The resectability of tumors was assessed based on CT scans of the chest and abdomen, and surgical approaches included Sweet surgery, Mckeown surgery, and Ivor-Lewis surgery. Patients were divided into a short-interval group (4 to <6 weeks) and a long-interval group (6 to 12 weeks) based on the interval between neoadjuvant immunochemotherapy and surgery. General patient data, surgical details, pathological response, and prognosis were collected and analyzed. Data comparisons were performed using independent sample -test, Mann-Whitney test, test, or Fisher's exact test. Multivariate logistic regression analysis was used to identify independent factors influencing pathological complete response (pCR). Survival analysis was conducted using the Kaplan-Meier method and Log-rank test. There were no significant differences in baseline characteristics, neoadjuvant treatment details, surgical outcomes, or postoperative complications between the long-interval group and the short-interval group (all >0.05). Multivariate Logistic regression analysis revealed that, among clinical factors, interval between neoadjuvant immunochemotherapy and surgery was significantly associated with pCR (long-interval group . short-interval group: =4.14, 95%:1.63 to 10.50, =0.003). The pCR rate was higher in the long-interval group (43.6% 17.1%, =6.48,=0.011). Survival analysis showed no significant differences in overall survival (=0.094) or disease-free survival (=0.840) between the two groups. Appropriately extending the surgical interval after neoadjuvant immunochemotherapy maybe lead to a higher pCR rate, without increasing surgical difficulty or damaging prognosis.
探讨新辅助免疫治疗联合化疗（nICT）与手术之间的间隔时间对患者病理结果和预后的影响。这是一项回顾性队列研究。纳入了2020年1月至2024年4月期间在北京大学人民医院胸外科或郑州大学第一附属医院胸外科接受nICT并随后序贯手术的115例局部晚期食管鳞状细胞癌患者。其中，男性99例，女性16例，年龄（四分位间距）为65（11）岁（范围：45至81岁）。所有患者均接受2至6周期的紫杉醇加铂类双药化疗联合PD -1免疫检查点抑制剂。根据胸部和腹部CT扫描评估肿瘤的可切除性，手术方式包括Sweet手术、McKeown手术和Ivor - Lewis手术。根据新辅助免疫化疗与手术之间的间隔时间，将患者分为短间隔组（4至<6周）和长间隔组（6至12周）。收集并分析患者的一般资料、手术细节、病理反应和预后。采用独立样本t检验、Mann - Whitney检验、χ²检验或Fisher精确检验进行数据比较。采用多因素逻辑回归分析确定影响病理完全缓解（pCR）的独立因素。采用Kaplan - Meier法和Log - rank检验进行生存分析。长间隔组和短间隔组在基线特征、新辅助治疗细节、手术结果或术后并发症方面均无显著差异（均>0.05）。多因素逻辑回归分析显示，在临床因素中，新辅助免疫化疗与手术之间的间隔时间与pCR显著相关（长间隔组对比短间隔组：比值比=4.14，95%置信区间：1.63至10.50，P =0.003）。长间隔组的pCR率更高（43.6%对比17.1%，χ²=6.48，P =0.011）。生存分析显示两组之间的总生存期（P =0.094）或无病生存期（P =0.840）无显著差异。新辅助免疫化疗后适当延长手术间隔时间可能会导致更高的pCR率，而不会增加手术难度或损害预后。
