Huang Yizhou, Chen Maohui, Zhou Liyuan, Cai Bingqiang, Zhang Yongcong, Lin Chuanquan, Zhang Shuliang, Zeng Taidui, Chen Chun, Zheng Bin
Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, China.
Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
Surg Endosc. 2025 Sep 11. doi: 10.1007/s00464-025-12166-6.
Neoadjuvant therapy (NAT) is the standard treatment for locally advanced esophageal cancer. Nevertheless, the response to NAT varies significantly among patients. This study is aimed at comparing the influence of different clinical decisions on disease-free survival (DFS) and overall survival (OS) in patients evaluated as stable disease (SD) or clinical response (CR/PR) after NAT.
This retrospective, multicenter cohort study included patients with locally advanced and resectable ESCC who underwent NAT from January 2016 to January 2022. After NAT, patients were classified into CR/PR and SD groups. Each group was further divided into surgical and non-surgical subgroups. Kaplan-Meier survival analysis was used to compare OS and DFS between groups, and Cox regression was used to identify independent prognostic factors.
A total of 518 patients were included, with 286 classified as CR/PR and 232 as SD. In the SD group, 170 patients (73.3%) underwent surgery, while 62 (26.7%) refused. In the CR/PR group, 246 patients (86.0%) underwent surgery, and 40 (14.0%) refused. Survival analysis revealed that surgery significantly improved OS and DFS in the SD group, and multivariate analysis identified surgery as an independent prognostic factor for both OS and DFS. In the CR/PR group, surgery significantly improved DFS and was an independent factor for DFS, but it did not significantly impact long-term OS.
In patients with clinically stable disease, surgery significantly improves both DFS and OS. In patients with clinical response, surgery improves DFS but has no significant impact on long-term OS.
新辅助治疗（NAT）是局部晚期食管癌的标准治疗方法。然而，患者对NAT的反应差异很大。本研究旨在比较不同临床决策对新辅助治疗后评估为疾病稳定（SD）或临床缓解（CR/PR）的患者无病生存期（DFS）和总生存期（OS）的影响。
这项回顾性多中心队列研究纳入了2016年1月至2022年1月期间接受NAT的局部晚期且可切除的食管鳞癌患者。NAT后，患者被分为CR/PR组和SD组。每组进一步分为手术和非手术亚组。采用Kaplan-Meier生存分析比较组间的OS和DFS，并采用Cox回归确定独立预后因素。
共纳入518例患者，其中286例分类为CR/PR，232例为SD。在SD组中，170例患者（73.3%）接受了手术，62例（26.7%）拒绝手术。在CR/PR组中，246例患者（86.0%）接受了手术，40例（14.0%）拒绝手术。生存分析显示，手术显著改善了SD组的OS和DFS，多因素分析确定手术是OS和DFS的独立预后因素。在CR/PR组中，手术显著改善了DFS，是DFS的独立因素，但对长期OS没有显著影响。
在临床疾病稳定的患者中，手术显著改善了DFS和OS。在临床缓解的患者中，手术改善了DFS，但对长期OS没有显著影响。
