Frontiers in immunology · 2026
Prognostic analysis of first-recurrence/metastasis esophageal squamous cell carcinoma: chemoimmunotherapy combined with radiotherapy as one of the optimal clinical management strategies.
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Li Yitong, Li Qiaofang, Wang Kuo, Gao Mengchang, Tian Lei, Liu Miaomiao, Bu Yuqing, Cui Yujie
Аннотация
BACKGROUND: The real-world efficacy and prognostic factors of First-line and subsequent-line treatment for first-recurrent/metastatic esophageal squamous cell cancer (ESCC) have not been fully evaluated.
METHODS: This single-institutional retrospective cohort study evaluated 156 first-recurrent/metastatic ESCC patients treated with First-line and subsequent-line treatment between January 2018 to January 2023. We assessed tumor response, long-term survival, and prognostic factors.
RESULTS: Among 156 ESCC patients with measurable lesions, in the first-line treatment setting, the combined Immunotherapy+Radiotherapy+Chemotherapy (IT+RT+CT) group had a lower incidence of progressive disease (PD) and Death compared with the Chemotherapy+Immunotherapy (CT+IT) group (80.0% vs 90.6%). First-Line Treatment were independent factors that affect progression-free survival (PFS), better PFS in the IT+RT+CT group compared to the CT+IT group (HR: 0.50, 95%CI: 0.28-0.90, P = 0.020). In the First-line and subsequent-line treatments, IT+RT+CT were identified as significant prognostic factors of overall survival (OS) through Cox proportional hazards analysis. After inverse probability of treatment weighting (IPTW) between the IT+RT+CT group and the CT+IT group in the First-line and Subsequent-line Treatments, the 1-, 2-year OS were 76.2% and 46.5% in the IT+RT+CT group, and 1-, 2-year OS were 39.5% and 19.4% in the CT+IT group, respectively (P = 0.011). In the doubly robust Cox proportional hazards model, which incorporated IPTW with weight trimming and adjustment for residual confounders (SMD>0.1), in the First-line and Subsequent-line Treatments, the IT+RT+CT regimen was significantly associated with improved OS compared to the CT+IT regimen (HR: 0.48, 95%CI: 0.27-0.85, P = 0.011).
CONCLUSIONS: Our study demonstrated that, IT+RT+CT as first-line treatment for recurrent/metastatic ESCC significantly prolonged PFS compared to CT+IT. Furthermore, IT+RT+CT extended OS in First-line and subsequent-line treatments. However, these findings require validation in prospective studies to confirm their clinical significance.
METHODS: This single-institutional retrospective cohort study evaluated 156 first-recurrent/metastatic ESCC patients treated with First-line and subsequent-line treatment between January 2018 to January 2023. We assessed tumor response, long-term survival, and prognostic factors.
RESULTS: Among 156 ESCC patients with measurable lesions, in the first-line treatment setting, the combined Immunotherapy+Radiotherapy+Chemotherapy (IT+RT+CT) group had a lower incidence of progressive disease (PD) and Death compared with the Chemotherapy+Immunotherapy (CT+IT) group (80.0% vs 90.6%). First-Line Treatment were independent factors that affect progression-free survival (PFS), better PFS in the IT+RT+CT group compared to the CT+IT group (HR: 0.50, 95%CI: 0.28-0.90, P = 0.020). In the First-line and subsequent-line treatments, IT+RT+CT were identified as significant prognostic factors of overall survival (OS) through Cox proportional hazards analysis. After inverse probability of treatment weighting (IPTW) between the IT+RT+CT group and the CT+IT group in the First-line and Subsequent-line Treatments, the 1-, 2-year OS were 76.2% and 46.5% in the IT+RT+CT group, and 1-, 2-year OS were 39.5% and 19.4% in the CT+IT group, respectively (P = 0.011). In the doubly robust Cox proportional hazards model, which incorporated IPTW with weight trimming and adjustment for residual confounders (SMD>0.1), in the First-line and Subsequent-line Treatments, the IT+RT+CT regimen was significantly associated with improved OS compared to the CT+IT regimen (HR: 0.48, 95%CI: 0.27-0.85, P = 0.011).
CONCLUSIONS: Our study demonstrated that, IT+RT+CT as first-line treatment for recurrent/metastatic ESCC significantly prolonged PFS compared to CT+IT. Furthermore, IT+RT+CT extended OS in First-line and subsequent-line treatments. However, these findings require validation in prospective studies to confirm their clinical significance.