Efficacy and safety of neoadjuvant chemotherapy and immunotherapy in locally resectable advanced esophageal squamous cell carcinoma.
Efficacy and safety of neoadjuvant chemotherapy and immunotherapy in locally resectable advanced esophageal squamous cell carcinoma.
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局部可切除晚期食管鳞癌新辅助化疗和免疫治疗的疗效和安全性。
DOI：
10.21037/jtd-21-340
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发表时间：
2021-06
影响因子：
2.5
通讯作者：
Zhang Y
中科院分区：
文献类型：
--
作者：
Wu Z;Zheng Q;Chen H;Xiang J;Hu H;Li H;Pan Y;Peng Y;Yao X;Liu P;Sun Y;Li B;Zhang Y
食管鳞状细胞癌（ESCC）患者具有潜在的可切除性疾病，手术后大多数会复发。免疫治疗已被报道可以改善晚期食管癌的预后，并可能成为预防这种紧急情况复发的新策略。我们首先评估了新辅助化疗联合免疫治疗对可切除食管鳞癌患者的疗效和安全性。所有可切除的局部晚期ESCC患者（临床III-IVB期）。接受至少1个周期的新辅助化疗联合免疫治疗（NACI），每个周期与手术间隔至少3周。所有患者均接受标准手术治疗。在基线和手术前一周内获得肿瘤成像。疗效终点为主要病理学缓解率（MPR，10%活肿瘤细胞）。在手术样本中研究了化疗相关分子的表达。共纳入38例ESCC患者（36例男性，中位年龄61岁），其中大多数使用Pembrolizumab（55.26%）和Camrelizumab（31.58%）。我们分析了19例患者，发现13例（68.42%）患者通过CT图像获得放射学部分缓解（PR）。R 0切除35例（92.11%），术后并发症10例（26.32%）。术后病理学检查显示13例（34.21%）患者达到完全病理学反应（cPR），16例（42.11%）患者达到MPR。我们还发现，没有一个因素对MPR有统计学意义的影响。病灶直径之和（SLD）的消退率与病理缓解率呈显著正相关（P=0.012，r=0.565）。食管鳞癌MPR显示率达42.11%。NACI方案的使用并没有增加新辅助治疗和手术并发症的发生，SLD消退率对免疫治疗的效果有一定的指导意义。
Esophageal squamous cell cancer (ESCC) patients with the potentially resectable disease most would experience relapse after surgery. Immunotherapy has been reported to improve the prognosis of advanced esophageal cancer and may be a new strategy to prevent this urgent condition’s recurrence. We first evaluated the efficacy and safety of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable ESCC. All patients with resectable locally advanced ESCC (clinical stage III–IVB). Received at least 1 cycle of neoadjuvant chemotherapy combined with immunotherapy (NACI), and the interval between each cycle and the operation should be at least 3 weeks. All patients were treated with standard surgery. The tumor imaginations were obtained at baseline and within a week before surgery. The efficacy endpoint was the rate of major pathologic response (MPR, 10% viable tumor cells). Expression of immunohistochemical-related molecules was investigated in surgical samples. A total of 38 patients with ESCC were included (36 males, median age 61 years), and most of them used Pembrolizumab (55.26%) and Camrelizumab (31.58%). We analyzed 19 patients and found that 13 patients (68.42%) achieved radiological partial response (PR) by CT images. R0 resection was performed in 35 patients (92.11%), and 10 patients (26.32%) developed postoperative complications. Through postoperative pathology, we found 13 (34.21%) patients had complete pathologic response (cPR), and 16 (42.11%) patients achieved MPR. We also found that none of the factors had a statistically significant impact on MPR. Still, the regression rate of Sum of lesion diameter (SLD) was significantly positively correlated with the pathological remission rate (P=0.012, r=0.565). The rate of MPR in ESCC patients reached 42.11%. The use of the NACI regimen did not increase the occurrence of complications in neoadjuvant treatment and operation, and the SLD regression rate has a certain guiding significance for the effect of immunotherapy.
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影响因子：
8.4
作者：
Eisenhauer, E. A.;Therasse, P.;Verweij, J.
通讯作者：
Verweij, J.
影响因子：
16.9
作者：
Wang H;Tang H;Fang Y;Tan L;Yin J;Shen Y;Zeng Z;Zhu J;Hou Y;Du M;Jiao J;Jiang H;Gong L;Li Z;Liu J;Xie D;Li W;Lian C;Zhao Q;Chen C;Zheng B;Liao Y;Li K;Li H;Wu H;Dai L;Chen KN
通讯作者：
Chen KN
影响因子：
45.3
作者：
Kelsen, David P.;Winter, Katryn A.;Willett, Christopher G.
通讯作者：
Willett, Christopher G.
影响因子：
3.7
作者：
Ando, Nobutoshi;Kato, Hoichi;Fukuda, Haruhiko
通讯作者：
Fukuda, Haruhiko
影响因子：
9
作者：
Heneghan, Helen M.;Donohoe, Claire;Reynolds, John V.
通讯作者：
Reynolds, John V.