新辅助化学放射治疗与食道状细胞癌的化学免疫治疗
Xufeng Guo1, Chunji Chen1, Jinbo Zhao2
1Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
JAMA surgery
|March 19, 2025
概括
与化学辐射疗法 (NCRT) 相比,新辅助化学免疫疗法 (NCIT) 显著改善了局部晚期食道状细胞癌 (ESCC) 的存活率. NCIT减少了远程转移,导致更好的整体和无疾病生存率.
科学领域:
- 在瘤学瘤学.
- 胃肠道手术 胃肠道手术
- 医学瘤学 医学瘤学
背景情况:
- 新辅助化学免疫疗法 (NCIT) 与新辅助化学放射疗法 (NCRT) 对局部晚期食道状细胞癌 (ESCC) 的比较有效性尚未得到充分证实.
- 关于这些新辅助治疗对ESCC瘤衰退和患者存活率的影响的证据有限.
研究的目的:
- 为了比较NCIT和NCRT与瘤回归和局部发达ESCC患者的长期存活的关联.
- 评估新辅助治疗策略对关键生存和病理反应终点的影响.
主要方法:
- 一项比较有效性研究,涉及1428名在NCRT或NCIT后接受食道切除术的局部发达ESCC患者.
- 2016年1月至2023年3月期间,从中国的8个高体积食道手术中心收集了数据,后续调查持续到2024年3月.
- 倾向性得分匹配被用来创建可比较的组 (每组532名患者) 来分析2年整体存活率 (OS),无病存活率 (DFS),主要病理反应 (MPR) 和病理完整反应 (pCR).
主要成果:
- 与接受NCIT治疗的患者相比,接受NCIT治疗的患者在2年内显著增加了OS (81.3%vs71.3%) 和DFS (73.9%vs63.4%),而非NCRT治疗的患者则显著增加了OS (81.3%vs71.3%).
- NCRT组显示出较高的MPR率 (71.8%对61.5%),而pCR率在两组之间是相似的 (25.9%对22.9%).
- NCIT与总体复发率和远程转移率较低有关,局部区域转移率没有显著差异.
结论:
- 与新辅助化学免疫疗法 (NCIT) 相比,新辅助化学辐射疗法 (NCRT) 与局部晚期食道状细胞癌患者的2年整体存活率和无病存活率的改善有关.
- 远程转移的减少似乎是NCIT观察到的生存益处的一个关键因素.
- 需要进一步的前性随机临床试验来验证这些发现并确认NCIT的优越性.
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