新辅助化学免疫治疗对比标准放化疗治疗局部晚期食管鳞状细胞癌
Neoadjuvant Chemoimmunotherapy Versus Standard Chemoradiotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma.
作者
作者单位
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
- School of Nursing, Sun Yat-sen University, Guangzhou, People's Republic of China.
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China. fujh@mail.sysu.edu.cn.
摘要
中文
新辅助化学免疫治疗（NCIT）与标准放化疗（NCRT）相比对局部晚期食管鳞状细胞癌（LA-ESCC）的长期生存结局仍不清楚。回顾性分析了2007年6月至2022年12月期间接受NCRT或NCIT后行根治性食管切除术的LA-ESCC患者。NCRT组患者接受长春瑞滨和顺铂联合放疗的统一方案，而NCIT组接受PD-1抑制剂联合化疗。比较两组在应用逆概率处理加权（IPTW）前后的病理结局、总生存期（OS）和无病生存期（DFS）。共纳入462例患者（NCIT 232例；NCRT 230例）。中位随访期为51.5个月（四分位距33.0-87.0个月）。IPTW校正分析显示，NCIT组的3年OS高于NCRT组（79.7% vs 68.2%；风险比[HR] 0.51；95%置信区间[CI] 0.28-0.91；P=0.023）。多项敏感性分析结果一致。两组3年DFS无显著差异（73.9% vs 62.7%；HR 0.65；95% CI 0.40-1.05；P=0.076）。病理完全缓解率相当（NCIT 33.6% vs NCRT 41.0%；P=0.229）。术后2年内，NCIT的总体复发率（15.8% vs 28.8%；P=0.033）和远处转移率（6.6% vs 17.0%；P=0.006）低于NCRT，而局部区域复发率相似（8.7% vs 11.8%；P=0.592）。在这个完成新辅助治疗并接受根治性切除的LA-ESCC患者回顾性队列中，NCIT与更好的OS相关。
English
The long-term survival outcomes of neoadjuvant chemoimmunotherapy (NCIT) compared with neoadjuvant chemoradiotherapy (NCRT) for locally advanced esophageal squamous cell carcinoma (LA-ESCC) remain unclear. Patients with LA-ESCC who underwent curative esophagectomy after receiving either NCRT or NCIT between June 2007 and December 2022 were retrospectively analyzed. The patients in the NCRT group received a uniform regimen of vinorelbine and cisplatin with concurrent radiotherapy, whereas those in the NCIT group received a PD-1 inhibitor combined with chemotherapy. Pathologic outcomes, overall survival (OS), and disease-free survival (DFS) were compared between the groups before and after application of inverse probability of treatment-weighting (IPTW). Overall, 462 patients were included (232 with NCIT; 230 with NCRT). The median follow-up period was 51.5 months (interquartile range, 33.0-87.0 months). The IPTW-adjusted analyses showed higher 3-year OS with NCIT versus NCRT (79.7 vs 68.2%; hazard ratio [HR] 0.51; 95% confidence interval [CI] 0.28-0.91; P = 0.023). Multiple sensitivity analyses yielded consistent results. The 3-year DFS did not differ significantly between the two groups (73.9 vs 62.7%; HR, 0.65; 95% CI 0.40-1.05; P = 0.076). Pathologic complete response rates were comparable (NCIT, 33.6% vs NCRT, 41.0%; P = 0.229). Within 2 years postoperatively, NCIT had lower rates of overall recurrence (15.8 vs 28.8; P = 0.033) and distant metastases (6.6 vs 17.0%, P = 0.006) than NCRT, whereas the locoregional recurrence rate was similar (8.7 vs 11.8%; P = 0.592). In this retrospective cohort of selected patients with LA-ESCC who completed neoadjuvant therapy and underwent curative resection, NCIT was associated with better OS than NCRT.
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
- 3.8
- 新锐分区
- 2区