目的:本研究旨在比较新辅助免疫化疗(nICT)和新辅助放化疗(nCRT)治疗局部晚期食管鳞状细胞癌(LA-ESCC)的围手术期结局和预后的差异。
方法:从2018年1月至2022年3月复旦大学附属中山医院前瞻性维护的数据库中确定了接受nICT或nCRT的LA-ESCC患者。进行倾向评分匹配(PSM)以平衡两组。
结果:共有124对患者纳入最终分析。完全病理反应率(20.2%vs.29.0%,p=0.140)两组相似,而主要病理反应率较低(44.4%vs.61.3%,在nICT组中观察到p=0.011)。nICT与较低的不良事件发生率相关(42.7%与55.6%,p=0.047),无额外的术后并发症(38.7%vs.35.5%,p=0.693)。nICT组有较低的远处转移(6.5%vs.16.1%,p=0.027)和总体复发率(11.3%vs.23.4%,术后1年p=0.019)。此外,nICT与更好的无进展生存期相关(HR=0.50;95%CI:0.32-0.77;p=0.002)。Cox比例风险分析表明,nICT(单变量:HR=0.55;95%CI:0.37-0.82;p=0.003;多变量:HR=0.44;95%CI:0.29-0.65;p<0.001)是无进展生存的独立预后因素之一。在最近的随访中,两组的总生存率相似(HR=0.62;95CI:0.36-1.09;p=0.094)。
结论:这项回顾性研究表明,nICT对LA-ESCC患者是安全有效的。随机对照试验需要进一步验证。
OBJECTIVE: This study aimed to compare the difference in perioperative outcomes and prognosis between neoadjuvant
immunochemotherapy and neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma.
METHODS: The patients with locally advanced esophageal squamous cell carcinoma receiving neoadjuvant immunochemotherapy or neoadjuvant chemoradiotherapy were identified from a prospectively maintained database at Zhongshan Hospital of Fudan University between January 2018 and March 2022. Propensity score matching was performed to balance the 2 groups.
RESULTS: A total of 124 patient pairs were enrolled in the final analysis. The complete pathological response rate (20.2% vs 29.0%, P = .140) was similar in the 2 groups, whereas the lower major pathological response rate (44.4% vs 61.3%, P = .011) was observed in the neoadjuvant immunochemotherapy group. Neoadjuvant
immunochemotherapy was associated with a lower rate of adverse events (42.7% vs 55.6%, P = .047) without additional postoperative complications (38.7% vs 35.5%, P = .693). The neoadjuvant immunochemotherapy group had lower distant metastasis (6.5% vs 16.1%, P = .027) and overall recurrence (11.3% vs 23.4%, P = .019) in the postoperative 1 year. Also, neoadjuvant
immunochemotherapy was associated with better progression-free survival (hazard ratio, 0.50; 95% CI, 0.32-0.77; P = .002). Cox proportional hazard analysis showed that neoadjuvant
immunochemotherapy (univariable: hazard ratio, 0.55; 95% CI, 0.37-0.82; P = .003; multivariable: hazard ratio, 0.44; 95% CI, 0.29-0.65; P < .001) was one of the independent prognostic factors for progression-free survival. The 2 groups had similar overall survival (hazard ratio, 0.62; 95% CI, 0.36-1.09; P = .094) at the latest follow-up.
CONCLUSIONS: This retrospective study showed that neoadjuvant
immunochemotherapy was safe and effective for patients with locally advanced esophageal squamous cell carcinoma. Further verification is needed in randomized controlled trials.