Surgical endoscopy · 2025
The enhanced pathological response from additional immunotherapy improved recurrence-free survival for esophageal squamous cell carcinoma: a multi-center cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Xie Shuhan, Xu Hui, Xu Jinxin, Tang Zilu, Huang Shijie, Xie Jinbiao, Xu Rongyu, Ke Sunkui, Zhang Hai, Kang Mingqiang
Аннотация
BACKGROUND: Immunotherapy shows promise in enhancing pathological responses in locally advanced esophageal squamous cell carcinoma (LA-ESCC), but its long-term survival benefits remain uncertain. This study aims to evaluate the impact of adding immunotherapy to neoadjuvant chemotherapy (nCT) on survival in ESCC patients.
METHODS: From five medical centers, 273 ESCC patients were studied, receiving either neoadjuvant chemoimmunotherapy (nICT) or nCT. Recurrence-free survival (RFS) was the primary endpoint, with locoregional recurrence-free survival (L-RFS) and distant metastasis-free survival (D-MFS) as secondary endpoints. To address confounding biases, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized. An 18-month landmark analysis and Kaplan-Meier curves assessed survival differences.
RESULTS: The pathological response was significantly improved in the nICT group compared to the nCT group. Cox analysis confirmed nICT as an independent factor associated with better prognosis (HR = 3.05, 95% CI 1.81-5.14, p < 0.001). Before matching, the nICT group showed superior RFS (p < 0.001), L-RFS (p = 0.002), and D-MFS (p < 0.001). After PSM, nICT showed its advantage in RFS (p < 0.001) and D-MFS (p = 0.003), with a trend toward improved L-RFS (p = 0.075). Similarly, after IPTW, nICT maintained its survival benefit in RFS (p = 0.001), D-MFS (p = 0.015), with an observed trend toward enhanced L-RFS (p = 0.085). Stratified analyses revealed greater survival benefits of nICT in patients with ypStage III/IV (p < 0.001). The 18-month landmark analysis demonstrated that nICT significantly enhanced RFS (p < 0.001), L-RFS (p = 0.048), and D-MFS (p < 0.001) with the first 18 months after surgery.
CONCLUSION: nICT substantially improves prognostic outcomes in LA-ESCC patients, especially in terms of D-MFS and the period of the first 18-month post-surgery, suggesting nICT could be a more effective treatment strategy. Besides, more prospective investigations are required to substantiate these findings.
METHODS: From five medical centers, 273 ESCC patients were studied, receiving either neoadjuvant chemoimmunotherapy (nICT) or nCT. Recurrence-free survival (RFS) was the primary endpoint, with locoregional recurrence-free survival (L-RFS) and distant metastasis-free survival (D-MFS) as secondary endpoints. To address confounding biases, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized. An 18-month landmark analysis and Kaplan-Meier curves assessed survival differences.
RESULTS: The pathological response was significantly improved in the nICT group compared to the nCT group. Cox analysis confirmed nICT as an independent factor associated with better prognosis (HR = 3.05, 95% CI 1.81-5.14, p < 0.001). Before matching, the nICT group showed superior RFS (p < 0.001), L-RFS (p = 0.002), and D-MFS (p < 0.001). After PSM, nICT showed its advantage in RFS (p < 0.001) and D-MFS (p = 0.003), with a trend toward improved L-RFS (p = 0.075). Similarly, after IPTW, nICT maintained its survival benefit in RFS (p = 0.001), D-MFS (p = 0.015), with an observed trend toward enhanced L-RFS (p = 0.085). Stratified analyses revealed greater survival benefits of nICT in patients with ypStage III/IV (p < 0.001). The 18-month landmark analysis demonstrated that nICT significantly enhanced RFS (p < 0.001), L-RFS (p = 0.048), and D-MFS (p < 0.001) with the first 18 months after surgery.
CONCLUSION: nICT substantially improves prognostic outcomes in LA-ESCC patients, especially in terms of D-MFS and the period of the first 18-month post-surgery, suggesting nICT could be a more effective treatment strategy. Besides, more prospective investigations are required to substantiate these findings.