Perioperative outcomes and survival after neoadjuvant immunochemotherapy for locally advanced esophageal squamous cell carcinoma.

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-01-01 Epub Date: 2024-06-27 DOI:10.1016/j.jtcvs.2024.06.020

Xinyu Yang, Hao Yin, Shaoyuan Zhang, Tian Jiang, Jianmin Gu, Heng Jiao, Hao Wang, Fei Liang, Songtao Xu, Hong Fan, Jianyong Ding, Di Ge, Qun Wang, Jun Yin, Lijie Tan

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Abstract

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.

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新辅助免疫化疗治疗局部晚期食管鳞状细胞癌的围手术期疗效和生存率

研究目的本研究旨在比较新辅助免疫化疗（nICT）和新辅助化放疗（nCRT）治疗局部晚期食管鳞癌（LA-ESCC）围手术期疗效和预后的差异：从2018年1月至2022年3月期间复旦大学附属中山医院的前瞻性数据库中识别出接受nICT或nCRT治疗的LA-ESCC患者。进行倾向评分匹配（PSM）以平衡两组患者：共有124对患者纳入最终分析。两组的完全病理反应率（20.2% vs. 29.0%，p=0.140）相似，而nICT组的主要病理反应率较低（44.4% vs. 61.3%，p=0.011）。nICT组的不良事件发生率较低（42.7% vs. 55.6%，p=0.047），且无额外的术后并发症（38.7% vs. 35.5%，p=0.693）。nICT 组术后 1 年的远处转移率（6.5% 对 16.1%，P=0.027）和总复发率（11.3% 对 23.4%，P=0.019）较低。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比例危险分析显示，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结论：这项回顾性研究表明，nICT对LA-ESCC患者安全有效。需要在随机对照试验中进一步验证。

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.