两种新辅助联合方案治疗食管鳞癌30例病理学评估  

Pathological evaluation of 30 cases of esophageal squamous cell carcinoma after two neoadjuvant therapies

作　　者：吴翌楠 张静渊[1] 江宁[2] 赵丽君[2] 宋雪[2] 许琦涔 任斌辉[3] 郭震[4] 徐新宇[1] 蒋明[1] 朱向帜[2] Wu Yi'nan;Zhang Jingyuan;Jiang Ning;Zhao Lijun;Song Xue;Xu Qicen;Ren Binhui;Guo Zhen;Xu Xinyu;Jiang Ming;Zhu Xiangzhi(Department of Pathology,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Radiation Oncology,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Thoracic Surgery,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Image,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院&江苏省肿瘤防治研究所&南京医科大学附属肿瘤医院病理科,南京210009 [2]江苏省肿瘤医院&江苏省肿瘤防治研究所&南京医科大学附属肿瘤医院放疗科,南京210009 [3]江苏省肿瘤医院&江苏省肿瘤防治研究所&南京医科大学附属肿瘤医院胸外科,南京210009 [4]江苏省肿瘤医院&江苏省肿瘤防治研究所&南京医科大学附属肿瘤医院影像科,南京210009

出　　处：《中华放射肿瘤学杂志》2023年第1期15-21,共7页Chinese Journal of Radiation Oncology

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2020-13-5);江苏省肿瘤医院基金(ZJ2021117)。

摘　　要：目的探讨局部晚期食管鳞癌经不同新辅助治疗(新辅助放化疗及新辅助特瑞普利单抗联合放化疗)后, 根治术切除标本之间的组织病理学差异。方法收集2020年10月至2021年9月期间于江苏省肿瘤医院接受新辅助治疗后手术切除食管鳞癌患者30例, 其中行新辅助放化疗者(放化疗组)15例, 行新辅助特瑞普利单抗联合放化疗者(放化免组)15例。收集患者手术标本, 分析并比较两组食管原发灶组织病理学特征及受累淋巴结反应之间的差异。结果放化疗组及放化免组病理显著缓解(MPR)率分别为10/15及14/15(P=0.17), 原发灶病理完全缓解(pCR)率分别为7/15及10/15(P=0.46);出现三级淋巴样结构(TLS)者分别为7/15及12/15(P=0.02), 出现坏死者分别为6/15及1/15(P=0.03), 泡沫样组织细胞出现率分别为6/15及13/15(P=0.01), 受累淋巴结治疗后的pCR率分别为7/33及11/12(P<0.001)。结论相比于放化疗组, 放化免组更容易出现TLS、泡沫样组织细胞聚集, 同时坏死出现的频率更低, 且已受累的淋巴结治疗反应更好, 提示新辅助特瑞普利单抗联合放化疗方案具有更强的免疫协同效应。Objective To explore the pathological differences of surgically resected specimens of advanced esophageal squamous cell carcinoma(ESCC)to different neoadjuvant therapies(neoadjuvant radiochemotherapy and toripalimab combined with neoadjuvant radiochemotherapy).Methods Thirty patients diagnosed with advanced ESCC who underwent surgical operation after neoadjuvant therapy in Jiangsu Cancer Hospital from October 2020 to September 2021 were included.Among them,15 patients received neoadjuvant radiochemotherapy(radiochemotherapy group)and 15 patients were treated with toripalimab combined with radiochemotherapy(immunotherapy combined with radiochemotherapy group).Surgically resected specimens were collected.The histopathological features of primary esophageal lesions and the responses of involved lymph nodes were analyzed and compared between two groups.Results The major pathological response(MPR)rate in the radiochemotherapy group was 10/15,and 14/15 in the immunotherapy combined with radiochemotherapy group(P=0.17).The pathological complete response(pCR)rate of the primary lesions in the radiochemotherapy group was 7/15,and 10/15 in the immunotherapy combined with radiochemotherapy group(P=0.46).In the radiochemotherapy group,the incidence rate of tertiary lymphoid structure(TLS)was 7/15,and 12/15 in the immunotherapy combined with radiochemotherapy group(P=0.02).The incidence rate of necrosis in the radiochemotherapy group was 6/15,and 1/15 in the immunotherapy combined with radiochemotherapy group(P=0.03).In addition,the incidence rate of foam cell infiltration in the radiochemotherapy group was 6/15,and 13/15 in the immunotherapy combined with radiochemotherapy group(P=0.01).Furthermore,the pCR rate of involved lymph nodes in the radiochemotherapy group was 7/33,and 11/12 in the immunotherapy combined with radiochemotherapy group(P<0.001).Conclusion Compared with the radiochemotherapy group,the incidence of TLS and foam cell infiltration is higher,the incidence of necrosis is lower and clinical efficacy of involv

关 键 词：食管肿瘤 新辅助疗法 瘤床 淋巴结 

分 类 号：R735.1[医药卫生—肿瘤]