新辅助治疗后不同病理结局的非pCR食管鳞癌患者生存差异
Survival Differences Among Non-pCR Patients with Distinct Pathological Outcomes After Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma.
作者
作者单位
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center , School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang,China.
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China.
- Clinical Research Center for Thoracic Tumors of Fujian Province, Fuzhou, China; Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, China.
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China; Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, China.
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, University of Science and Technology of China (USTC), Hefei, China; Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China.
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China.
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China.
- Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China; Department of Radiation Oncology, The First Affiliated Hospital of USTC, University of Science and Technology of China (USTC), Hefei, China.
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China; Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, China.
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China.
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: m18930096739@163.com.
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China. Electronic address: doc.leng@uestc.edu.cn.
摘要
中文
非病理完全缓解(non-pCR)患者占新辅助治疗后食管鳞癌(ESCC)病例的大多数,但不同病理结局——特别是主要病理缓解(MPR)联合淋巴结(LN)状态——的预后意义仍缺乏明确定义。本研究旨在阐明其预后价值,并优化术后评估体系。本多中心回顾性队列研究纳入2016年至2023年间在中国8家高容量食管切除中心接受新辅助放化疗(nCRT)或新辅助免疫化疗(nICT)后行R0切除的ESCC患者。主要比较为nCRT与nICT队列,同时按计划对病理缓解亚组及早期与进展期病理分期队列进行额外分析。采用倾向性评分匹配平衡基线特征,通过Kaplan-Meier和Cox回归分析比较生存结局。匹配后,nICT的pCR率与nCRT相似,但淋巴结清扫范围更广,且远处复发率显著降低(P < 0.001)。在病理亚型中,MPR(+)LN(-)的远期预后最佳,优于或相当于pCR,而MPR(-)LN(+)预后最差(P<0.001)。值得注意的是,MPR(+)LN(-)患者在早期与进展期队列中生存率相近,提示病理分期的预后影响减弱,凸显其主导的预测价值。MPR联合淋巴结阴性的患者远期生存与pCR相当,提示多维病理评估可提高预后准确性。与nCRT相比,nICT在不同病理结局中均显示出更好的淋巴结清除和全身疾病控制趋势。
English
Non-pathological complete response (non-pCR) patients constitute the majority of esophageal squamous cell carcinoma (ESCC) cases after neoadjuvant therapy, yet the prognostic implications of different pathological outcomes-particularly major pathological response (MPR) combined with lymph node (LN) status-remain inadequately defined. This study aimed to elucidate their prognostic value and refine postoperative evaluation systems. This multicenter retrospective cohort study included patients with ESCC from eight high-volume esophagectomy centers in China who underwent neoadjuvant chemoradiotherapy (nCRT) or immunochemotherapy (nICT) followed by R0 resection between 2016 and 2023. The primary comparison was between the nCRT and nICT cohorts, with additional planned analyses of pathological-response subgroups and early versus advanced pathological-stage cohorts. Propensity score matching was used to balance baseline characteristics, and survival outcomes were compared using Kaplan-Meier and Cox regression analyses. After matching, nICT demonstrated similar pCR rates to nCRT but achieved more extensive nodal dissection and significantly reduced distant recurrence (P < 0.001). Among pathological subtypes, MPR(+)LN(-) yielded the most favorable long-term outcomes, surpassing or comparable to those of pCR, whereas MPR(-)LN(+) was associated with the worst prognosis (P<0.001). Notably, MPR(+)LN(-) patients had comparable survival between early- and advanced-stage cohorts, suggesting a reduced prognostic impact of pathological stage, underscoring its dominant predictive value. Patients with MPR combined with LN negativity had long-term survival comparable to pCR, suggesting that multidimensional pathological evaluation may improve prognostic accuracy. Compared with nCRT, nICT showed better trends in nodal clearance and systemic disease control across different pathological outcomes.
分类与指标
- 研究类型
- 临床研究
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 4.7