新辅助免疫治疗联合化疗与新辅助放化疗治疗局部晚期可切除食管鳞状细胞癌的短期疗效比较

Comparison of short-term efficacy of neoadjuvant immunotherapy combined with chemotherapy and neoadjuvant chemoradiation for locally advanced resectable esophageal squamous cell carcinoma

目的探讨新辅助免疫治疗联合化疗治疗局部晚期食管鳞状细胞癌的短期疗效。方法回顾性分析高州市人民医院2019年8月—2020年10月期间行新辅助治疗食管鳞状细胞癌患者的临床资料。根据新辅助治疗方案,将患者分为新辅助免疫治疗联合化疗组和新辅助放化疗组。比较两组患者新辅助治疗前基线资料、新辅助治疗期间不良事件发生率、围手术期相关指标、术后病理缓解率及术后并发症发生情况。结果共纳入33例患者,其中男15例、女18例,平均年龄(62.37±7.99)岁,新辅助免疫治疗联合化疗组17例,新辅助放化疗组16例。新辅助免疫治疗联合化疗组以食管中下段癌为主,临床分期Ⅱ期5例,Ⅲ期9例,Ⅳa期3例;新辅助放化疗组以中上段癌为主,临床分期Ⅱ期1例,Ⅲ期15例。新辅助治疗期间两组发生骨髓抑制、胃肠道反应差异无统计学意义(P>0.05),新辅助免疫治疗联合化疗组出现4例免疫相关皮疹,新辅助放化疗组出现1例食管穿孔。新辅助免疫治疗联合化疗组按期完成手术14例(82.35%),新辅助放化疗组按期完成手术12例(75.00%),新辅助免疫治疗联合化疗组术后停留ICU时间及术后胸腔引流管留置时间均比新辅助放化疗组短(P<0.05)。新辅助免疫治疗联合化疗组术后病理完全缓解5例,新辅助放化疗组术后病理完全缓解6例;两组患者术后病理退缩分级及残留肿瘤细胞比较差异无统计学意义(P>0.05)。两组完成手术患者围手术期吻合口瘘、胸腔胃瘘、支气管纵隔瘘、腹胀、肺部感染、脑卒中、声音嘶哑发生率差异无统计学意义(P>0.05)。新辅助放化疗组围手术期死亡2例,死亡原因为胸腔胃瘘并发重症感染。结论局部晚期食管癌患者采用新辅助免疫治疗联合化疗未明显增加不良事件发生,并显示出良好的病理缓解率,是一项安全、可行及具有潜力的新治疗模式。

Objective To investigate the short-term therapeutic effect of neoadjuvant immunotherapy combined with chemotherapy in the locally advanced esophageal squamous cell carcinoma.Methods The clinical data of patients with esophageal squamous cell carcinoma treated with neoadjuvant treatment in Gaozhou People's Hospital from August2019 to October 2020 were retrospectively analyzed.According to the different treatments,the patients were divided into two groups:a neoadjuvant immunotherapy combined with chemotherapy group(NIC group)and a neoadjuvant chemoradiotherapy group(NC group).The baseline data,incidence of adverse events during treatment,perioperative indicators,postoperative pathological remission rate and incidence of postoperative complications were compared between the two groups.Results Totally 33 patients were enrolled,including 15 males and 18 females,with an average age of 62.37±7.99 years.There were 17 patients in the NIC group and 16 patients in the NC group.In the NIC group,the carcinoma was mainly located in the middle and lower esophagus,with 5 paitents in stageⅡ,9 patients in stageⅢ,and 3patients in stageⅣa.In the NC group,the carcinoma was mainly located in the upper-middle esophagus,with 1 patient in stageⅡand 15 patients in stageⅢ.During the neoadjuvant treatment,there was no significant difference in the occurrence of bone marrow suppression or gastrointestinal reactions between the two groups(P0.05).There were 4immune-related rashes in the NIC group and 1 esophageal perforation in the NC group.Fourteen(82.35%)patients in the NIC group and 12(75.00%)patients in the NC group completed the operation on schedule.The postoperative ICU stay time and chest tube indwelling time in the NIC group were shorter than those in the NC group(P0.05).There were 5patients of complete remission in the NIC group,and 6 patients in the NC group.There was no significant difference in the pathological regression grade or residual tumor cells between the two groups(P0.05).There was no significant difference in the incidence of anastomotic fistula,thoracic gastric fistula,bronchial mediastinal fistula,abdominal distension,pulmonary infection,stroke,or hoarseness during the perioperative period between the two groups of patients who completed the operation(P0.05).In the NC group,2 patients died during the perioperative period because of thoracic gastric fistula complicated by severe infection.Conclusion Neoadjuvant immunotherapy combined with chemotherapy dose not significantly increase the occurrence of adverse events and shows a good rate of pathological remission,which indicates that the neoadjuvant immunotherapy combined with chemotherapy is a safe,feasible and potential new treatment model.