局部晚期可切除食管癌新辅助治疗疗效及预后分析

Analysis of the efficacy and prognosis of neoadjuvant therapy for locally advanced resectable esophageal cancer

目的分析局部晚期可切除食管癌新辅助治疗的真实临床效果及预后。方法回顾性分析2019年1月至2021年12月于四川省南充市中心医院行不同新辅助治疗的201例局部晚期可切除食管癌患者, 根据新辅助治疗方式不同, 将患者分为新辅助放化疗组(n=87)、新辅助免疫化疗组(n=69)、新辅助化疗组(n=45), 患者完成新辅助治疗后4~6周均行手术治疗。比较3组患者术后病理缓解情况。采用Kaplan-Meier法绘制生存曲线并行log-rank检验, 分析3组患者总生存(OS)率、局部无复发生存(LRFS)率、远处无转移生存(DMFS)率。结果新辅助放化疗组、新辅助免疫化疗组、新辅助化疗组患者病理完全缓解率分别为33.3%(29/87)、40.6%(28/69)、13.3%(6/45), 差异有统计学意义(χ^(2)=9.68, P=0.008);新辅助放化疗组及新辅助免疫化疗组明显高于新辅助化疗组, 差异均有统计学意义(χ^(2)=6.09, P=0.014;χ^(2)=9.66, P=0.002);新辅助放化疗组与新辅助免疫化疗组比较, 差异无统计学意义(χ^(2)=0.87, P=0.351)。3组患者主要病理缓解率分别为58.6%(51/87)、59.4%(41/69)、31.1%(14/45), 差异有统计学意义(χ^(2)=10.89, P=0.004);新辅助放化疗组及新辅助免疫化疗组明显高于新辅助化疗组, 差异有统计学意义(χ^(2)=8.98, P=0.003;χ^(2)=8.74, P=0.003);新辅助放化疗组与新辅助免疫化疗组比较, 差异无统计学意义(χ^(2)=0.10, P=0.920)。3组患者3年OS率分别为43.7%、42.0%、33.3%, 差异无统计学意义(χ^(2)=0.79, P=0.347)。3组患者3年LRFS率分别为67.8%、66.7%、46.7%, 差异有统计学意义(χ^(2)=7.58, P=0.023);新辅助放化疗组及新辅助免疫化疗组明显高于新辅助化疗组, 差异均有统计学意义(χ^(2)=4.17, P=0.041;χ^(2)=4.15, P=0.042);新辅助放化疗组及新辅助免疫化疗组比较, 差异无统计学意义(χ^(2)=0.01, P=0.923)。3组患者3年DMFS率分别为37.9%、37.7%、28.9%, 差异无统计学意义(χ^(2)=0.14, P=0.707)。结论不同新辅助治疗方式治疗局部晚期可切除食管癌疗效不同, 新辅助放化疗及新辅助免疫治疗能够获得更好的病理缓解率及LRFS率。

Objective To analyze the real clinical effects and prognosis of neoadjuvant therapy for locally advanced resectable esophageal cancer.Methods Two hundred and one patients with locally advanced resectable esophageal cancer who underwent different neoadjuvant treatments at Nanchong Central Hospital of Sichuan Province from January 2019 to December 2021 were retrospective analyzed.Patients were divided into neoadjuvant chemoradiotherapy group(n=87),neoadjuvant immunochemotherapy group(n=69),and neoadjuvant chemotherapy group(n=45)according to the different methods of neoadjuvant therapy.Patients underwent surgical treatment 4-6 weeks after completing neoadjuvant therapy.The postoperative pathological response of three groups of patients were compared.Kaplan-Meier method was used to draw survival curves.Log-rank tests were performed to analyze overall survival(OS)rate,local recurrence-free survival(LRFS)rate,and distant metastasis-free survival(DMFS)rate in three groups of patients.Results The pathological complete response rates of the neoadjuvant chemoradiotherapy group,neoadjuvant immunochemotherapy group and neoadjuvant chemotherapy group were 33.3%(29/87),40.6%(28/69)and 13.3%(6/45),respectively,with a statistically significant difference(χ^(2)=9.68,P=0.008).The pathological complete response rates in the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were higher than that in the neoadjuvant chemotherapy group,with statistically significant differences(χ^(2)=6.09,P=0.014;χ^(2)=9.66,P=0.002);there was no statistically significant difference between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group(χ^(2)=0.87,P=0.351).The major pathologic response rates of the three groups were 58.6%(51/87),59.4%(41/69)and 31.1%(14/45),respectively,with a statistically significant difference(χ^(2)=10.89,P=0.004).The major pathologic response rates of the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were significantly higher than that of the neoadjuvant chemotherapy group,with statistically significant differences(χ^(2)=8.98,P=0.003;χ^(2)=8.74,P=0.003);there was no statistically significant difference between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group(χ^(2)=0.10,P=0.920).The 3-year OS rates of the three groups were 43.7%,42.0%and 33.3%,respectively,with no statistically significant difference(χ^(2)=0.79,P=0.347).The 3-year LRFS rates of the three groups were 67.8%,66.7%and 46.7%,respectively,with a statistically significant difference(χ^(2)=7.58,P=0.023),the LRFS rates in the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were significantly higher than that in the neoadjuvant chemotherapy group,with statistically significant differences(χ^(2)=4.17,P=0.041;χ^(2)=4.15,P=0.042);there was no statistically significant difference in LRFS rates between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group(χ^(2)=0.01,P=0.923).The 3-year DMFS rates of the three groups were 37.9%,37.7%and 28.9%,respectively,with no statistically significant difference(χ^(2)=0.14,P=0.707).Conclusion Different neoadjuvant therapies have different therapeutic effects in the treatment of locally advanced resectable esophageal cancer,neoadjuvant chemoradiotherapy and neoadjuvant immunochemotherapy can achieve a better pathological response rates and LRFS rates.