新辅助化学免疫治疗与放化疗联合免疫治疗在局部晚期食管鳞状细胞癌中的临床结局：倾向性评分匹配分析
Clinical Outcomes of Neoadjuvant Chemoimmunotherapy Versus Chemoradiation Combined with Immunotherapy in Locally Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis.
作者
作者单位
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China. yongyuan@scu.edu.cn.
摘要
中文
新辅助化学免疫治疗（NCIT）已成为食管鳞状细胞癌（ESCC）患者的一种有前景的策略。然而，新辅助放化疗联合免疫治疗（NCRI）是否能进一步提高疗效仍不确定。本研究前瞻性入组并回顾性分析了2019年12月至2025年1月期间接受新辅助治疗的557例连续局部晚期ESCC患者。参与者被分为两个治疗队列：接受NCIT的队列和接受NCRI的队列。为了减轻潜在的选择偏倚并确保两组间基线特征均衡，实施了1:1倾向性评分匹配（PSM）方案，纳入多个临床相关协变量，以评估短期病理结局和长期生存。PSM后，这些基线特征均衡良好，每组124例患者。NCRI组表现出更优的病理结局，病理完全缓解（pCR）率显著更高（41.1%对19.4%；P<0.001），肿瘤退缩评分（TRS）更低（P<0.001），但术后肺部并发症发生率也更高（37.1%对16.9%；P<0.001）。尽管存在这些差异，在随访期间两组的总体生存期（OS；P=0.837）或无病生存期（DFS；P=0.429）均无显著差异。与单独NCIT相比，在NCIT基础上加用放疗显著提高了pCR率，但术后肺部并发症发生率更高。然而，这一病理获益并未转化为OS或DFS的长期生存优势。
English
Neoadjuvant chemoimmunotherapy (NCIT) has emerged as a promising strategy for patients with esophageal squamous cell carcinoma (ESCC). However, whether neoadjuvant chemoradiation-immunotherapy (NCRI) can further improve therapeutic efficacy remains uncertain. This study prospectively enrolled and retrospectively analyzed 557 consecutive patients with locally advanced ESCC who underwent neoadjuvant therapy between December 2019 and January 2025. The participants were stratified into two treatment cohorts: those receiving NCIT and those undergoing NCRI. To mitigate potential selection bias and ensure balanced baseline characteristics between groups, a 1:1 propensity score-matching (PSM) protocol was implemented incorporating multiple clinically relevant covariates to assess short-term pathologic outcomes and long-term survival. After PSM, these baseline characteristics were well balanced, with 124 patients in each group. The NCRI group demonstrated superior pathologic outcomes, with a significantly higher pathologic complete response (pCR) rate (41.1% vs 19.4%; P < 0.001) and a lower tumor regression score (TRS; P < 0.001), but also a higher incidence of postoperative pulmonary complications (37.1% vs 16.9%; P < 0.001). Despite these differences, no significant variation in overall survival (OS; P = 0.837) or disease-free survival (DFS; P = 0.429) was observed between the two groups during the follow-up period. The addition of radiotherapy to NCIT significantly improved pCR rates compared with NCIT alone, but was associated with a higher incidence of postoperative pulmonary complications. However, this pathologic benefit did not translate into superior long-term survival outcomes in either OS or DFS.
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