局部晚期可切除食管癌新辅助治疗疗效及预后分析

摘要/Abstract

摘要：

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（χ²=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（χ²=6.09，P=0.014；χ²=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（χ²=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（χ²=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（χ²=8.98，P=0.003；χ²=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（χ²=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（χ²=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（χ²=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（χ²=4.17，P=0.041；χ²=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（χ²=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（χ²=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。

关键词:食管肿瘤,放化疗,预后,新辅助治疗,免疫治疗,病理缓解

Abstract:

ObjectiveTo analyze the real clinical effects and prognosis of neoadjuvant therapy for locally advanced resectable esophageal cancer.MethodsTwo 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.ResultsThe 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 （χ²=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 （χ²=6.09，P=0.014；χ²=9.66，P=0.002）； there was no statistically significant difference between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group （χ²=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 （χ²=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 （χ²=8.98，P=0.003；χ²=8.74，P=0.003）； there was no statistically significant difference between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group （χ²=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 （χ²=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 （χ²=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 （χ²=4.17，P=0.041；χ²=4.15，P=0.042）； there was no statistically significant difference in LRFS rates between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group （χ²=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 （χ²=0.14，P=0.707）.ConclusionDifferent 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.

Key words:Esophageal neoplasms,Chemoradiotherapy,Prognosis,Neoadjuvant therapy,Immunotherapy,Pathological response

杨蜜, 别俊, 张加勇, 邓佳秀, 唐组阁, 卢俊. 局部晚期可切除食管癌新辅助治疗疗效及预后分析[J]. 国际肿瘤学杂志, 2024, 51(6): 332-337.

Yang Mi, Bie Jun, Zhang Jiayong, Deng Jiaxiu, Tang Zuge, Lu Jun. Analysis of the efficacy and prognosis of neoadjuvant therapy for locally advanced resectable esophageal cancer[J]. Journal of International Oncology, 2024, 51(6): 332-337.

图/表4

表1

3组局部晚期可切除食管癌患者一般临床资料比较（$\bar{x} \pm s$/例）"

一般临床资料	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）	F/χ²值	P值
年龄（岁）	54.8±8.2	54.5±9.3	58.2±7.1	0.03	>0.999
性别
男	80	63	41	0.04	0.983
女	7	6	4	0.04	0.983
体质量指数（kg/m²）
<18.5	17	12	8	0.13	0.935
≥18.5	70	57	37	0.13	0.935
吸烟史
有	73	58	36	0.39	0.822
无	14	11	9	0.39	0.822
饮酒史
有	82	63	40	1.24	0.537
无	5	6	5	1.24	0.537
肿瘤位置
胸上段	21	24	13	3.24	0.519
胸中段	43	32	19
胸下段	23	13	13
T分期
T₁	10	9	6	0.95	0.913
T₂	32	22	12
T₃	27	22	18
T₄	18	16	9
N分期
N₀	6	5	3	1.91	0.752
N₁	38	31	25
N₂	43	33	17
临床分期
Ⅱ	8	5	3	1.06	0.901
Ⅲ	63	49	35
Ⅳ	16	15	7

表1

图1

图2

图3

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