Li Yixin, Xiao Gang, Yang Bo, Hong Yidan, Chen Zeng, Gu Lingling, Kong Cheng, Zhao Lijun, Zhu Zihao, Xu Qicen, Chen Yu, Jiang Ming, Zhu Xiangzhi, Jiang Ning
Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China.
Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China.
Front Oncol. 2025 May 21;15:1573597. doi: 10.3389/fonc.2025.1573597. eCollection 2025.
The combination of immunotherapy with neoadjuvant chemotherapy (nICT) or chemoradiotherapy (nICRT) represents a novel treatment approach for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This study aimed to compare postoperative complications between patients who underwent esophagectomy directly and those who received surgery following neoadjuvant immunotherapy combining treatments (nIComT) including nICT or nICRT.
A retrospective analysis was conducted on patients with LA-ESCC at our center. A 1:1 propensity score matching (PSM) was used to eliminate baseline characteristics differences. The primary endpoint was postoperative complications, which were assessed based on the Esophageal Cancer Complications Consensus Group (ECCG) criteria, and the severity was evaluated according to the Clavien-Dindo classification.
After PSM, 116 matched patients were analyzed in both the surgery-alone and nIComT group. The overall complication rates between the two groups were similar (51.7% 56.0%, =0.510). Incidence of cardiovascular complications, most of which were grade I and II, was increased in the nIComT group compared with the surgery-alone group(=0.003). The higher rate of cardiovascular complications mainly due to hypotension (52.6% 42.2%, =0.004) requiring intervention including the use of vasopressors, or transfusion. Additionally, more patients in the nIComT group received perioperative transfusion (34.5% 14.7%, <0.001), as well as an extended operation duration (276 ± 66min 246 ± 63min, <0.001), when compared to the surgery-alone group. The logistic regression analyses of potential risk factors for cardiovascular complications showed that receiving neoadjuvant treatment was independently associated with cardiovascular complications (OR=2.03, 95% CI=1.15-3.57, =0.015).
Our study highlights an increased risk of cardiovascular complications among patients received nIComT, underscoring the significance of postoperative circulatory interventions. Further prospective studies are needed for validation.
免疫疗法与新辅助化疗（nICT）或放化疗（nICRT）联合使用，为局部晚期食管鳞状细胞癌（LA - ESCC）患者提供了一种新的治疗方法。本研究旨在比较直接接受食管切除术的患者与接受包括nICT或nICRT的新辅助免疫联合治疗（nIComT）后再进行手术的患者的术后并发症。
对本中心的LA - ESCC患者进行回顾性分析。采用1:1倾向评分匹配（PSM）来消除基线特征差异。主要终点是术后并发症，根据食管癌并发症共识组（ECCG）标准进行评估，并根据Clavien - Dindo分类评估严重程度。
PSM后，手术单独组和nIComT组各分析了116例匹配患者。两组的总体并发症发生率相似（51.7%对56.0%，P = 0.510）。与手术单独组相比，nIComT组心血管并发症的发生率增加，其中大多数为I级和II级（P = 0.003）。心血管并发症发生率较高主要是由于低血压（52.6%对42.2%，P = 0.004），需要进行包括使用血管加压药或输血在内的干预。此外，与手术单独组相比，nIComT组更多患者接受围手术期输血（34.5%对14.7%，P < 0.001），手术时间也更长（276 ± 66分钟对246 ± 63分钟，P < 0.001）。心血管并发症潜在危险因素的逻辑回归分析表明，接受新辅助治疗与心血管并发症独立相关（OR = 2.03，95%CI = 1.15 - 3.57，P = 0.015）。
我们的研究突出了接受nIComT的患者心血管并发症风险增加，强调了术后循环干预的重要性。需要进一步的前瞻性研究来验证。
