Background: The current National Comprehensive Cancer Network advises neoadjuvant chemoradiotherapy followed by surgery for locally advanced cases of esophageal cancer. The role of immunotherapy in this context is under heavy investigation. Methods: Patients with esophageal adenocarcinoma were identified in the National Cancer Database (NCDB) from 2004 to 2019. Three groups were generated as follows: (a) no immunotherapy, (b) neoadjuvant immunotherapy, and (c) adjuvant immunotherapy. Overall survival was evaluated using the Kaplan–Meier method and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Results: Of the total 14,244 patients diagnosed with esophageal adenocarcinoma who received neoadjuvant chemoradiation, 14,065 patients did not receive immunotherapy, 110 received neoadjuvant immunotherapy, and 69 received adjuvant immunotherapy. When adjusting for established risk factors, adjuvant immunotherapy was associated with significantly improved survival compared to no immunotherapy and neoadjuvant immunotherapy during a median follow-up period of 35.2 months. No difference was noted among patients who received no immunotherapy vs. neoadjuvant immunotherapy in the same model. Conclusions: In this retrospective analysis of the NCDB, receiving adjuvant immunotherapy offered a significant survival advantage compared to no immunotherapy and neoadjuvant immunotherapy in the treatment of esophageal adenocarcinoma. The addition of neoadjuvant immunotherapy to patients treated with neoadjuvant chemoradiation did not improve survival in this cohort. Further studies are warranted to investigate the long-term outcomes of immunotherapy in esophageal cancer.
背景：当前美国国家综合癌症网络指南建议，对于局部进展期食管癌患者，应采用新辅助放化疗后手术的治疗方案。免疫治疗在此背景下的作用正受到深入研究。方法：通过美国国家癌症数据库（NCDB）识别2004年至2019年诊断为食管腺癌的患者，并将其分为三组：（a）未接受免疫治疗组，（b）新辅助免疫治疗组，以及（c）辅助免疫治疗组。采用Kaplan-Meier法和Cox比例风险模型评估总生存期，并对已知的死亡风险因素进行校正。结果：在14,244例接受新辅助放化疗的食管腺癌患者中，14,065例未接受免疫治疗，110例接受新辅助免疫治疗，69例接受辅助免疫治疗。在中位随访35.2个月期间，校正既定风险因素后，辅助免疫治疗组相比未接受免疫治疗组及新辅助免疫治疗组显示出显著生存获益。在同一模型中，未接受免疫治疗组与新辅助免疫治疗组之间未观察到生存差异。结论：本项基于NCDB的回顾性分析表明，在食管腺癌治疗中，辅助免疫治疗相比未接受免疫治疗及新辅助免疫治疗具有显著生存优势。对于接受新辅助放化疗的患者，联合新辅助免疫治疗并未改善该队列的生存结局。未来需进一步研究以探讨免疫治疗在食管癌中的长期疗效。
肿瘤(癌症)患者之家