本期胸小星将为大家带来nCRT和nICT在局部晚期ESCC中病理缓解与生存结局比较；TD对ESCC新辅助治疗后经胸食管切除术的预后影响，一起来看看吧！
2017·EATTS
01
Yi Wang1, Ke Ma2, Huan Zhang3, Lei Wu1, Li Liu1, Yehan Zhou4, Lin Peng2, Qifeng Wang1 and Xiang Zhuang2,3
1. Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China.
2. Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China.
3. School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
4. Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
Background:
In locally advanced, operable esophageal squamous cell carcinoma (ESCC), neoadjuvant immunochemotherapy (nICT) has shown results that are somewhat comparable to those of standard neoadjuvant chemoradiotherapy (nCRT). The impact of these neoadjuvant treatments on survival outcomes, however, has yet to be elucidated.
Methods:
This study included 489 patients with locally advanced ESCC who underwent surgery at Sichuan Cancer Hospital after receiving neoadjuvant treatment between June 2017 and September 2023. Patients were categorized into nCRT and nICT groups based on whether they received neoadjuvant treatment. To mitigate potential biases and balance covariates between the two cohorts, 1:2 propensity score matching (PSM) was conducted using a caliper width of 0.05.
Results:
After PSM, the baseline characteristics of the 360 patients remained balanced between the two groups. The findings indicated a superior pathological response in the nCRT group, as evidenced by significantly greater rates of complete response (32.87% vs 14.58%, P < 0.001) and favorable tumor regression grade (TRG), as well as reduced ypT stages and less perineural and angioinvasion, despite comparable ypN stages. Despite the improvement in complete pathological response (pCR) in the nCRT group, the 3-year disease-free survival (DFS) and overall survival (OS) rates did not significantly differ between the groups (DFS: 58.32% vs 56.16%, P = 0.67; OS: 69.96% vs 71.99%, P = 0.99). Crucially, The nICT group showed a lower incidence of grade 3 and 4 adverse events in Leukopenia (2.8% vs 29%; P < 0.001) and Neutropenia (2.8% vs 24%; P < 0.001) during neoadjuvant treatment, comparing with nCRT group.
Conclusions:
Our preliminary findings suggest that nICT followed by surgery offers comparable survival rates to nCRT, despite being less effective in pathologic outcomes. Nonetheless, nICT is a safe and feasible strategy for locally advanced ESCC, warranting further exploration to understand its impact on long-term survival
[CITATION]: Wang Y, Ma K, Zhang H, et al. Comparison of pathologic response and survival outcomes between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant immunochemotherapy (nICT) in patients with locally advanced esophageal squamous cell carcinoma: a propensity score-matched analysis. BMC Cancer. 2024 Oct 5;24(1):1228.
[DOI]: 10.1186/s12885-024-12946-8.
[IF]: 3.4
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胸“星”外科学术团队成员 李洋 译
背景
方法
结果
结论
Figure 2. Disease-free survival (DFS) (A) and overall survival (OS) (B) in the 2 treatment groups before propensity score matching (PSM) and DFS (C)
and OS (D) in the matched samples.
Table 3. Pathologic Outcomes of Patients after PSM.
Table 4. Adverse Events During Neoadjuvant Treatment after PSM.
2017·EATTS
02
Prognostic Impact of Thoracic Duct Resection in Patients Who Underwent Transthoracic Esophagectomy Following Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma: Exploratory Analysis of JCOG1109
Satoru Matsuda1, Hiroya Takeuchi2, Ken Kato3, Ryunosuke Machida4, Yoshinori Ito5, Yasuhiro Tsubosa6, Hiroyuki Daiko7, Kazuo Koyanagi 8, Takashi Ogata9, Takashi Fukuda10, Takeo Fujita11, Tetsuya Abe12, Takeo Bamba13, Masayuki Watanabe14, Hirofumi Kawakubo1, Yuichi Shibuya15, Dai Otsubo16, Tomokazu Kakisita17, Tadayoshi Hashimoto4,18, Keita Sasaki4, Yuko Kitagawa1
1 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
2 Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
3 Department of Head and Neck and Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
4 Japan Clinical Oncology Group Data Center, National Cancer Center Hospital, Tokyo, Japan.
5 Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan.
6 Division of Esophageal Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.
7 Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan.
8 Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
9 Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
10 Department of Gastrointestinal Surgery, Saitama Cancer Center, Saitama, Japan.
11 Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
12 Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan.
13 Department of Gastroenterological Surgery, Niigata Cancer Center, Niigata, Japan.
14 Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
15 Department of Gastroenterological Surgery, Kochi Health Science Center, Kochi, Japan.
16 Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Japan.
17 Department of Surgery, Shikoku Cancer Center, Matsumoto, Japan.
18 Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
Background:
Although several studies have investigated whether thoracic duct (TD) resection improves prognosis, the conclusion remains controversial. JCOG1109 is a three-arm randomized phase III trial to confirm the survival advantage of docetaxel, cisplatin, 5-fluorouracil (DCF), and cisplatin plus 5-fluorouracil (CF) combined with radiotherapy (CF-RT) over CF as neoadjuvant treatment. The study aimed to evaluate the survival impact of TD resection and its association with neoadjuvant treatment and pathological response in patients enrolled in JCOG1109.
Method:
Clinicopathological factors, surgical results, and prognosis were compared between TD preserved and resected groups. The survival impact of TD resection was also evaluated in the subgroups on the basis of combinations of preoperative therapy and pathological response.
Results:
Between December 2012 and July 2018, 601 patients were randomized (CF/DCF/CF-RT; 199/202/200) in JCOG1109. Of them, 541 patients underwent esophagectomy (183/181/177), and TD was resected in 265 patients (93/91/81). For the entire cohort, TD resection was not a significant prognostic factor for overall survival in the multivariable analysis (HR 1.20, 95% CI 0.91-1.57). In the subgroup analyses by combinations of neoadjuvant treatment and pathological response, TD resected group had a significantly better overall survival compared with TD preserved group in patients who received DCF and achieved pathological response (HR 0.20, 95% CI 0.07-0.61).
Conclusions:
The survival benefit of TD resection was not demonstrated in patients with surgically resectable esophageal squamous cell carcinoma enrolled in JCOG1109. The residual tumor burden after neoadjuvant treatment might be linked to the survival impact of TD resection.
[CITATION]: Satoru Matsuda, Hiroya Takeuchi, Ken Kato, et al. Prognostic Impact of Thoracic Duct Resection in Patients Who Underwent Transthoracic Esophagectomy Following Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma: Exploratory Analysis of JCOG1109. Ann Surg Oncol. 2024 Oct 7.
[DOI]:10.1245/s10434-024-16303-8.
[IF]: 3.4
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胸导管切除术对食管鳞状细胞癌患者新辅助治疗后接受经胸食管切除术的的预后影响：JCOG1109的探索性分析
胸“星”外科学术团队成员 赵阳 译
目的
方法
结果
结论
Figure 2. Overall survival between the thoracic duct (TD) preserved and resected groups based on the subgroup using neoadjuvant treatment and pathological response; CF cisplatin + fuorouracil, DCF docetaxel + cisplatin + fuorouracil, CF-RT, CF, cisplatin + fuorouracil + radiation of 41.4Gy
Figure 3. Progression-free survival between the thoracic duct (TD) preserved and resected groups based on the subgroup using neoadjuvant treatment and pathological response; CF cisplatin + fuorouracil, DCF docetaxel + cisplatin + fuorouracil, CF-RT, CF, cisplatin + fuorouracil + radiation of 41.4Gy
2017·EATTS
