目的:本研究旨在比较一线化疗联合放疗与单纯化疗对IVB期食管鳞状细胞癌(ESCC)患者的疗效和安全性。
方法:我们回顾性检查了409例接受一线化疗和抗PD-1抗体治疗的IVBESCC患者,对原发病灶进行或不进行≥40Gy辐射剂量的放疗,从2018年10月至2022年12月之间的四个学术癌症中心。进行倾向评分匹配(PSM)以最小化潜在的混杂效应。
结果:在409名患者的总体队列中,接受额外放疗的组的总生存期(OS)(风险比[HR]:0.51,95%置信区间[CI]:0.39~0.66,P<0.001)和无进展生存期(PFS)(HR:0.52,95%CI:0.40~0.66,P<0.001)均优于接受单独化疗的组.1:1PSM后,匹配年龄,肿瘤位置,和转移部位,共选择250例患者进行进一步分析.结果保持一致,并显示放疗的增加显着改善了OS和PFS(中位OS:24.9vs.14.6个月,P=0.003;PFS中位数:14.2vs.10.6个月,P=0.002)。多因素Cox分析包括肿瘤位置,T级,转移部位,和治疗方式,显示放疗是OS(HR:0.57,95%CI:0.41-0.81)和PFS(HR:0.63,95%CI:0.47-0.86)的独立预后因素。亚组分析显示,仅接受放疗的非区域淋巴结转移患者的OS显着延长(HR:0.49,95%CI:0.34-0.70)。在有远处器官转移的患者中没有观察到OS生存获益(HR:0.72,95%CI:0.46-1.13)。关于安全,接受额外放疗组的3-4级淋巴细胞减少发生率较高(74.4%vs.17.7%,P<0.001)和食管炎(11.2%vs.2.4%,P=0.006)。
结论:在化学免疫疗法中增加放疗可改善非区域淋巴结转移的IVBESCC患者的生存率。
OBJECTIVE: This study aimed to compare the efficacy and safety of combining first-line chemoimmunotherapy with radiation therapy versus chemoimmunotherapy alone in patients with stage IVB esophageal squamous cell carcinoma (ESCC).
METHODS: We retrospectively examined 409 patients with stage IVB ESCC who received first-line chemotherapy and anti-PD-1 antibody, with or without radiation therapy of ≥40 Gy radiation dose to primary lesion, from 4 academic cancer centers between October 2018 and December 2022. Propensity score matching was conducted to minimize the potential confounding effects.
RESULTS: In the overall cohort of 409 patients, the group that received additional radiation therapy had superior overall survival (OS) (hazard ratio [HR], 0.51; 95% CI, 0.39-0.66; P < .001) and progression-free survival (PFS) (HR, 0.52; 95% CI, 0.40-0.66; P < .001) compared to the group that received chemoimmunotherapy alone. After 1:1 propensity score matching, matching age, tumor location, and metastatic sites, a total of 250 patients were selected for further analysis. The results remained consistent and showed that the addition of radiation therapy significantly improved OS and PFS (median OS, 24.9 vs 14.6 months; P = .003; median PFS, 14.2 vs 10.6 months; P = .002). Multivariate Cox analysis including tumor location, T stage, metastatic sites, and treatment modality, revealed that radiation therapy was an independent prognostic factor for both OS (HR, 0.57; 95% CI, 0.41-0.81) and PFS (HR, 0.63, 95% CI, 0.47-0.86). Subgroup analyses revealed significant OS prolongation in patients with nonregional lymph node metastases only who received radiation therapy (HR, 0.49; 95% CI, 0.34-0.70). No OS survival benefit was observed in those with distant organ metastases (HR, 0.72; 95% CI, 0.46-1.13). Regarding safety, the group receiving additional radiation therapy had higher incidences of grade 3 to 4 lymphopenia (74.4% vs 17.7%, P < .001) and esophagitis (11.2% vs 2.4%, P = .006).
CONCLUSIONS: The addition of radiation therapy to chemoimmunotherapy improved the survival of stage IVB ESCC patients with nonregional lymph node metastasis.