新辅助+免疫治疗对胸段食管鳞癌淋巴结转移模式和疗效的影响及相关因素分析  

The influence of neoadjuvant and immunotherapy on lymph node metastasis pattern and efficacy of thoracic esophageal squamous cell carcinoma and analysis of related factors

作　　者：薛磊[1] 陆志斌[1] 甑福喜 骆金华[1] XUE Lei;LU Zhibin;ZENG Fuxi;LUO Jinhua(Department of Thoracic Surgery,the First Affiliated Hospital with Nanjing Medical University,Jiangsu Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院胸外科,江苏南京210029

出　　处：《现代肿瘤医学》2024年第12期2214-2218,共5页Journal of Modern Oncology

基　　金：江苏省南京市卫生科技发展项目(编号:YKK22230)。

摘　　要：目的:探讨新辅助+免疫治疗对胸段食管鳞癌淋巴结转移模式及疗效的影响并对相关因素进行分析。方法:回顾性分析本院收治的90例行食管癌根治术的胸段食管鳞癌患者病例资料,根据不同治疗方式分为手术组(n=27)、手术联合新辅助化疗组(n=30)、手术联合新辅助+免疫治疗组(n=33),对比3组淋巴结转移模式、病理完全缓解(pCR)率,分析影响食管鳞癌患者pCR率的因素。结果:3组治疗后胸上段常见淋巴结转移部位的转移率未见明显差异(P>0.05)。手术联合新辅助+免疫治疗组患者的胸中段淋巴结及胸下段的隆突下淋巴结、胃左动脉旁淋巴结转移率低于手术联合新辅助化疗组及单纯手术组(P<0.05)。干预后,手术联合新辅助+免疫治疗组、手术联合新辅助化疗分期低于手术组,说明手术联合新辅助+免疫治疗及手术联合新辅助化疗有降期作用(P<0.05)。多因素分析显示,肿瘤直径小、无淋巴结转移及手术联合新辅助+免疫治疗是pCR率的独立影响因素。结论:新辅助+免疫治疗胸段食管鳞癌后可降低淋巴结转移率,改变淋巴结转移模式,且肿瘤直径、淋巴结转移和新辅助+免疫治疗是影响pCR的重要因素,临床治疗过程中还需结合淋巴结转移模式及pCR的影响因素调整淋巴结清除和术后辅助治疗方式。Objective:To explore the impact of neoadjuvant+immunotherapy on lymph node metastasis pattern and efficacy of thoracic esophageal squamous cell carcinoma and analyze relevant factors.Methods:The data of 90 patients with thoracic esophageal squamous cell carcinoma who underwent radical esophagectomy for esophageal cancer in our hospital were retrospectively analyzed.The patients were divided into the surgery group(n=27),surgery combined with neoadjuvant chemotherapy group(n=30),and the surgery combined with neoadjuvant+immunotherapy group(n=33)according to different treatment methods.The lymph node metastasis patterns and the pathological complete response(pCR)rates were compared among the three groups,and the factors affecting the pCR rate of patients with esophageal squamous cell carcinoma were analyzed.Results:There was no significant difference in the metastatic rate of common lymph node metastases in the upper thoracic segment among the three groups after treatment(P>0.05).The metastatic rates of lymph nodes in the middle thoracic segment,subcarinal lymph nodes in the lower thoracic segment,and lymph nodes adjacent to the left gastric artery in the surgery combined with neoadjuvant+immunotherapy group were lower than those in the surgery combined with neoadjuvant chemotherapy group and the surgery group(P<0.05).The stage in the surgery combined with neoadjuvant+immunotherapy group and surgery combined with neoadjuvant chemotherapy was lower than that in the surgery group,suggested that in surgery combined with neoadjuvant+immunotherapy and surgery combined with neoadjuvant chemotherapy had a downstaging effect(P<0.05).Multivariate analysis showed that small tumor diameter,no lymph node metastasis,and surgery combined with neoadjuvant+immunotherapy were independent influencing factors of pCR rate.Conclusion:Neoadjuvant+immunotherapy for the treatment of thoracic esophageal squamous cell carcinoma can reduce the metastasis rate of lymph node and change lymph node metastasis pattern,and tumor diameter,lymph node

关 键 词：食管鳞癌 新辅助治疗 免疫治疗 淋巴结转移模式 PCR 

分 类 号：R735.1[医药卫生—肿瘤]