Tumor Remission and Tumor-Infiltrating Lymphocytes During Chemoradiation Therapy: Predictive and Prognostic Markers in Locally Advanced Esophageal Squamous Cell Carcinoma
Tumor Remission and Tumor-Infiltrating Lymphocytes During Chemoradiation Therapy: Predictive and Prognostic Markers in Locally Advanced Esophageal Squamous Cell Carcinoma
复制标题
放化疗期间的肿瘤缓解和肿瘤浸润淋巴细胞：局部晚期食管鳞状细胞癌的预测和预后标志物
DOI：
10.1016/j.ijrobp.2019.06.079
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发表时间：
2019-10-01
影响因子：
7
通讯作者：
Pang, Qingsong
中科院分区：
文献类型：
--
作者：
Qian, Dong;Wang, Yuwen;Pang, Qingsong
目的：临床工具无法准确预测术前食管鳞状细胞癌（ESCC）患者对放化疗（CRT）的病理反应。我们评估了肿瘤缓解和肿瘤浸润淋巴细胞（TILs）在CRT作为预测的病理反应和预后标志物与新辅助CRT（新CRT）或确定性CRT治疗的局部晚期食管鳞癌患者。方法和材料：我们分析了局部晚期食管鳞癌患者（N = 164）谁接受新CRT（N = 48）或确定性CRT（N = 116）。患者在诱导CRT结束时接受内镜超声检查和活检。肿瘤缓解特征被指定为轻微（-/+）至极好缓解（ER）（+）。以10%的增量确定TIL。肿瘤缓解，TILs，或两者都与病理学完全反应（pCR）和生存在新CRT组，然后在明确的CRT group.Results分析：ER和淋巴细胞为主的ESCC（LPE; >= 60%TILs）被确定根据pCR率和无病生存。我们建立了一个预测模型的pCR纳入ER和LPE。受试者工作特征曲线下面积为0.877，敏感性和特异性分别为86.7%和90.9%。此外，该模型以出色的校准识别病理反应。ER和LPE肿瘤患者的无病生存期显着长于其他patients.Conclusions：当我们包括肿瘤缓解和TILs在CRT，我们的模型预测pCR的概率很高，并有助于分层预后亚组，从而指导未来的治疗决策与局部晚期食管鳞癌患者。在大型、前瞻性、多中心研究中验证该模型至关重要。(C)2019年，任作家。爱思唯尔公司出版
Purpose: Clinical tools are unavailable for accurate prediction of pathologic responses to chemoradiation therapy (CRT) among patients with esophageal squamous cell carcinoma (ESCC) before surgery. We evaluated tumor remission and tumor-infiltrating lymphocytes (TILs) during CRT as predictors of pathologic response and prognostic markers for patients with locally advanced ESCC treated with neoadjuvant CRT (neo-CRT) or definitive CRT.Methods and Materials: We analyzed patients with locally advanced ESCC (N = 164) who underwent neo-CRT (N = 48) or definitive CRT (N = 116). Patients underwent endoscopic ultrasonography and biopsies when induction CRT finished. Tumor remission characteristics were designated minor (-/+) to excellent remission (ER) (+++). TILs were determined in 10% increments. Tumor remission, TILs, or both were associated with pathologic complete response (pCR) and survival in the neo-CRT group and then analyzed in the definitive CRT group.Results: ER and lymphocyte-predominant ESCC (LPE; >= 60% TILs) were identified according to the pCR rate and disease-free survival. We built a prediction model for pCR incorporating ER and LPE. The area under the receiver operating characteristic curve was 0.877, and sensitivity and specificity were 86.7% and 90.9%, respectively. Furthermore, this model identified pathologic response with an excellent calibration. Disease-free survival of patients with ER and LPE tumors was significantly longer than that of other patients.Conclusions: When we included tumor remission and TILs during CRT, our model predicted pCR with high probability and helped stratify prognostic sub-groups, thereby guiding future therapy decisions for patients with locally advanced ESCC. Validation of this model in larger, prospective, multicenter studies is essential. (C) 2019 The Authors. Published by Elsevier Inc.