Liu Chia, Yeh Yi-Chen, Chien Ling-I, Huang Chien-Sheng, Hsu Han-Shui, Hsu Po-Kuei
Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Chest Surg. 2025 Jul 5;58(4):134-145. doi: 10.5090/jcs.25.024.
The CheckMate 577 trial demonstrated that adjuvant nivolumab improves disease-free survival in patients with resected esophageal cancer following neoadjuvant chemoradiotherapy. This study aimed to evaluate real-world outcomes associated with adjuvant immunotherapy.
Patients with esophageal cancer and residual pathological disease who underwent neoadjuvant therapy followed by surgical resection between January 2019 and February 2024 were retrospectively analyzed. Participants were grouped by adjuvant treatment received: no adjuvant therapy, adjuvant immunotherapy (AI), or adjuvant chemotherapy (AC). Primary outcomes included overall survival (OS) and recurrence-free survival (RFS). Subgroup analyses were performed for patients meeting CheckMate 577 eligibility criteria and those with pathological node-positive (ypN+) status.
The study included 127 patients (mean age: 60 years; male: 86%): 23 received AI, 36 AC, and 68 received no adjuvant therapy. There were no significant differences in OS between AI and AC groups (median OS [mOS]: 34 months vs. 34 months; p=0.81), nor in RFS (median RFS [mRFS]: 15 months vs. 16 months; p=0.94). In the CheckMate 577-eligible subgroup (n=68), OS and RFS were similar between AI and AC groups (mOS: 25 months vs. 47 months; p=0.16; mRFS: 19 months vs. 20 months; p=0.74). Likewise, among ypN+ patients (n=54), no significant differences in OS or RFS were noted between AI and AC (mOS: 34 months vs. 31 months; p=0.74; mRFS: 9.5 months vs. 14 months; p=0.89).
AI did not demonstrate a significant survival advantage compared to AC, even in patients meeting CheckMate 577 criteria or those with ypN+ status. Identifying the optimal adjuvant treatment for esophageal cancer remains a challenging and evolving issue.
CheckMate 577试验表明，辅助使用纳武利尤单抗可改善新辅助放化疗后接受手术切除的食管癌患者的无病生存期。本研究旨在评估辅助免疫治疗的实际疗效。
对2019年1月至2024年2月期间接受新辅助治疗后行手术切除且有残留病理疾病的食管癌患者进行回顾性分析。参与者根据接受的辅助治疗分组：无辅助治疗、辅助免疫治疗（AI）或辅助化疗（AC）。主要结局包括总生存期（OS）和无复发生存期（RFS）。对符合CheckMate 577纳入标准的患者和病理淋巴结阳性（ypN+）状态的患者进行亚组分析。
该研究纳入了127例患者（平均年龄：60岁；男性：86%）：23例接受AI，36例接受AC，68例未接受辅助治疗。AI组和AC组的OS无显著差异（中位OS [mOS]：34个月对34个月；p=0.81），RFS也无显著差异（中位RFS [mRFS]：15个月对16个月；p=0.94）。在符合CheckMate 577标准的亚组（n=68）中，AI组和AC组的OS和RFS相似（mOS：25个月对47个月；p=0.16；mRFS：19个月对20个月；p=0.74）。同样，在ypN+患者（n=54）中，AI组和AC组的OS或RFS无显著差异（mOS：34个月对31个月；p=0.74；mRFS：9.5个月对14个月；p=0.89）。
即使在符合CheckMate 577标准的患者或ypN+状态的患者中，与AC相比，AI也未显示出显著的生存优势。确定食管癌的最佳辅助治疗仍然是一个具有挑战性且不断发展的问题。
