张耀文,汪晨宇,程欣宇,郭莹,任润川,金琳芝,王韶花.不同模式新辅助治疗食管癌的疗效分析[J].中华放射医学与防护杂志,2024,44(6):489-496
不同模式新辅助治疗食管癌的疗效分析
Efficacy of different types of neoadjuvant therapy for esophageal cancer
投稿时间:2023-10-27  
DOI:10.3760/cma.j.cn112271-20231027-00144
中文关键词:  食管肿瘤  疗效评估  食管肿瘤/新辅助化学疗法  食管肿瘤/新辅助放化疗法  食管肿瘤/新辅助化学联合免疫治疗
英文关键词:Esophageal cancer  Efficacy evaluation  Neoadjuvant chemotherapy for esophageal cancer  Neoadjuvant chemoradiotherapy for esophageal cancer  Neoadjuvant chemotherapy plus immunotherapy for esophageal cancer
基金项目:河南省中青年卫健委科技创新杰青人才项目(YXKC2021045);河南省科技攻关项目(212102310702)
作者单位邮编
张耀文 河南省安阳市肿瘤医院放疗科 河南科技大学附属安阳市肿瘤医院 河南省食管癌精准防治医学重点实验室 455000
汪晨宇 河南省安阳市肿瘤医院放疗科 河南科技大学附属安阳市肿瘤医院 河南省食管癌精准防治医学重点实验室 455000
程欣宇 河南省安阳市肿瘤医院放疗科 河南科技大学附属安阳市肿瘤医院 河南省食管癌精准防治医学重点实验室 455000
郭莹 河南省安阳市肿瘤医院放疗科 河南科技大学附属安阳市肿瘤医院 河南省食管癌精准防治医学重点实验室 455000
任润川 河南省安阳市肿瘤医院放疗科 河南科技大学附属安阳市肿瘤医院 河南省食管癌精准防治医学重点实验室 455000
金琳芝 河南省安阳市肿瘤医院放疗科 河南科技大学附属安阳市肿瘤医院 河南省食管癌精准防治医学重点实验室 455000
王韶花 河南省安阳市肿瘤医院放疗科 河南科技大学附属安阳市肿瘤医院 河南省食管癌精准防治医学重点实验室 455000
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中文摘要:
      目的 探讨食管癌不同模式新辅助治疗的疗效分析。 方法 回顾性分析2015年1月至2022年5月于安阳市肿瘤医院行新辅助治疗的食管鳞癌(ESCC)患者的资料,共纳入542例患者,其中放化疗(NCRT)组137例,化疗(NCT)组241例,免疫加化疗(NICT)组164例;女性198例,男性344例;≤65岁289例,>65岁253例。首要研究终点包括主要病理缓解(MPR)率、病理完全缓解(pCR) 率,次要研究终点包括总生存(OS)、无进展生存(PFS)和安全性。生存分析采用Kaplan-Meier方法,并采用Log-rank检验进行组间比较。采用Cox比例风险回归模型进行预后因素分析。 结果 NCRT组的MPR率和pCR率分别为66.4%(91/137)和35.8%(49/137),NCT组分别为35.3%(85/241)和6.6%(16/241),NICT组分别为63.4%(104/164)和31.1%(51/164)(χ2=1.67, P < 0.001)。NCRT组的1、2、3年的OS分别为89.8%、82.3%、72.3%,NCT组分别为85.9%、71.4%、61.4%,NICT组分别为91.9%、81.5%、77.8%,差异有统计学意义(χ2=9.20,P < 0.01);NCRT组的1、2、3年的PFS分别为81.5%、67.9%、66.6%,NCT组分别75.9%、61.0%、53.5%,NICT组分别为80.1%、65.5%、65.3%,差异有统计学意义(χ2=4.62,P<0.05)。多因素分析显示,治疗方式、T分期、N分期是OS的独立影响因素(P<0.05)。3组不良反应及术后并发症差异无统计学意义(P>0.05)。 结论 与NCT对比,NICT与NCRT有更高的pCR、MPR和生存获益,因此新辅助免疫可作为食管癌术前治疗手段之一,但仍需大型的随机对照研究进一步证实。
英文摘要:
      Objective To investigate the efficacy of different types of neoadjuvant therapy for esophageal cancer. Methods The clinical data of 542 patients with esophageal squamous cell carcinoma (ESCC) who received neoadjuvant therapy in Anyang Tumor Hospital of Science and Technology from January 2015 to May 2022 were retrospectively analyzed. These patients, consisting of 198 females and 344 males, with 289 cases aging ≤ 65 and 253 cases aging >65, were divided into a neoadjuvant chemoradiotherapy (NCRT) group (137 cases), a neoadjuvant chemotherapy (NCT) group (241 cases), and a neoadjuvant immunotherapy plus chemotherapy (NICT) group (164 cases). In this study, primary endpoints included major pathological response (MPR) and pathologic complete response (pCR) rates, and secondary endpoints comprised overall survival (OS), progression-free survival (PFS), and safety. Survival analysis was performed using the Kaplan-Meier method, and inter-group comparisons were made using the Log-rank test. Furthermore, prognostic factors were analyzed based on the Cox proportional hazards regression model. Results The NCRT, NCT, and NICT groups exhibited MPR and pCR rates of 66.4% (91/137) and 35.3% (85/241), 63.4% (104/164) and 35.8% (49/137), and 6.6% (16/241) and 31.1% (51/164), respectively (χ2=1.67, P < 0.001). These groups displayed 1-, 2-, and 3-year OS rates of 89.8%, 85.9%, and 91.9%; 82.3%, 71.4%, and 81.5%; and 72.3%, 61.4%, and 77.8%, respectively, with significant differences (χ2=9.20, P < 0.01). Furthermore, they exhibited 1-, 2-, and 3-year PFS rates of 81.5%, 75.9%, and 80.1%; 67.9%, 61.0%, and 65.5%; and 66.6%, 53.5%, and 65.3%, respectively, with significant differences (χ2=4.62, P < 0.05). Multivariate analysis showed that therapeutic modality, T stage, and N stage were independent prognostic factors for OS (P < 0.05). Additionally, there was no difference in adverse reactions and postoperative complications among the three groups. Conclusions Compared to NCT, NICT and NCRT feature higher pCR and MPR rates, along with more survival benefits. Therefore, neoadjuvant immunotherapy has the potential to serve as a preoperative therapeutic modality for esophageal cancer, yet large-scale randomized controlled trials are still required for confirmation.
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