新辅助免疫化学疗法后的病理完整反应:持续的复发风险突出了分层管理的必要性
Chang Yuan1, Chunji Chen1, Zhichao Liu1
1Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, State Key Laboratory of Metabolic Dysregulation & Prevention and Treatment of Esophageal Cancer, Shanghai, P.R. China.
The Journal of thoracic and cardiovascular surgery
|February 28, 2026
概括
患有食道状细胞癌的患者在新辅助免疫化学疗法后达到病理完整反应,其生存率很好,但存在远程复发的风险. 先进的节点阶段预测复发,建议风险适应的管理,而不是常规辅助治疗.
科学领域:
- 在瘤学瘤学.
- 胃肠道瘤学 胃肠道瘤学
- 新辅助疗法是一种新辅助疗法.
背景情况:
- 在新辅助疗法后的病理完整反应 (pCR) 是食道状细胞癌 (ESCC) 的有利预后指标.
- 在新辅助免疫化学疗法 (nICT) 后获得pCR的ESCC患者的长期结果和复发模式尚未明确.
研究的目的:
- 在nICT后实现pCR的ESCC患者中描述复发模式.
- 在这个特定的患者队列中确定影响无复发生存 (RFS) 和整体生存 (OS) 的预后因素.
主要方法:
- 一项多中心的回顾性队列研究,涉及2135名ESCC患者,在26个中国中心 (2019-2023) 接受了nICT和手术治疗.
- 对474名获得PCR的患者的复发模式,RFS和OS的分析.
- 考克斯回归分析用于确定RFS和OS的独立预后因素.
主要成果:
- 22.2%的患者在nICT后实现了pCR. 在32.8个月的中位随访期内,12.7%的患者经历了复发,主要是2年内远程转移 (63.3%).
- 两年的RFS和OS率分别为89.6%和92.1%.
- 先进的临床结节阶段 (cN2-3) 是较低RFS的独立预测因素 (aHR=1.83),但辅助治疗没有显著影响生存率.
结论:
- 在nICT后实现pCR的ESCC患者表现出优异的短期结果,但仍然存在远期复发的风险.
- 先进的临床结节阶段是复发的重要风险因素,需要进一步调查.
- 对这些患者来说,风险适应的术后管理策略可能比常规辅助疗法更有益.
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