局部晚期食管鳞状细胞癌患者新辅助化疗联合免疫和新辅助放化疗的病理反应和生存结果的比较:倾向评分匹配分析

Comparison of pathologic response and survival outcomes between neoadjuvant immunochemotherapy(nICT)and neoadjuvant chemoradiotherapy(nCRT)in patients with locally advanced esophageal squamous cell carcinoma:A propensity score-matched analysis

目的:比较新辅助化疗联合免疫(nICT)与新辅助放化疗(nCRT)治疗局部晚期、可切除的食管鳞状细胞癌(ESCC)的病理反应和远期生存。方法:纳入接受新辅助治疗后手术切除的313例局部晚期食管鳞癌(ESCC)患者为研究对象。根据新辅助治疗方式将患者分为nICT组和nCRT组。按照1∶2匹配,采用倾向评分匹配(PSM)来平衡两组间因素。结果:PSM后共纳入146例患者,两组间的基线特征无统计学差异。nICT组病理完全缓解率(pCR)较低(11.54%vs.35.11%,P=0.004),神经侵犯(32.69%vs.12.77%,P=0.008)和脉管癌栓的比例相对nCRT组较高(40.38%vs.10.64%,P<0.001)。然而,nICT组和nCRT组的3年无病生存率(DFS)和总生存率(OS)相当[DFS(54.6%vs.53.8%,P=0.370);OS(62.8%vs.67.2%,P=0.400)]。结论:虽然nCRT在病理反应上更好,但这种成功并没有转化为生存的获益。在病理结果和新辅助治疗方式中存在更多影响生存的因素应该加以研究以阐明其关联。

Objective:To compare the pathologic response and long-term survival between neoadjuvant immunochemotherapy(nICT)and neoadjuvant chemoradiotherapy(nCRT)in patients with locally advanced esophageal squamous cell carcinoma(ESCC).Methods:313 patients with locally advanced ESCC underwent surgery were selected as the research subjects.According to the neoadjuvant approach,the patients were divided into two groups:nICT group and nCRT group.Using a caliper of 0.05,a 1∶2 propensity score matching(PSM)was employed to balance any potential bias across a number of factors between two groups.Results:After PSM,a total of 146 patients were included,and there was no statistically significant difference in baseline characteristics between the two groups.The nICT group demonstrated lower rates of pathologic complete responses(pCR)(11.54%vs.35.11%,P=0.004)compared to the nCRT group,but higher percentages of perineural invasion(32.69%vs.12.77%,P=0.008)and angioinvasion(40.38%vs.10.64%,P<0.001).Nevertheless,the 3-year disease free survival(DFS)and overall survival(OS)rates were comparable between the nICT group and the nCRT group[DFS(54.6%vs.53.8%,P=0.370),OS(62.8%vs.67.2%,P=0.400)].Conclusion:While nCRT is more successful in pathologic outcomes,this success has not translated into survival benefits.More parameters affecting survival among pathologic outcomes and the kind of neoadjuvant therapy should be investigated to clarify this association.