新辅助免疫联合化疗治疗在局部进展期食管鳞状细胞癌手术患者中的临床疗效分析

doi:10.3969/j.issn.1006-6233.2025.11.029

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摘要 目的: 探讨新辅助放化疗(nCRT)与新辅助免疫联合化疗(nCIT)在局部进展期食管鳞状细胞癌(ESCC)患者中的疗效、安全性及对术后恢复的影响。方法: 回顾性分析2021年1月至2023年12月空军军医大学第二附属医院所接收的165例局部进展期ESCC患者,根据新辅助治疗方案分为对照组(nCRT,n=62)和研究组(nCIT,n=103)。比较两组的术后病理缓解率、不良事件发生率、免疫功能变化、围手术期指标及术后并发症发生率。结果: 两组R0切除率、病理完全缓解率(pCR)及主要病理缓解率(MPR)差异无统计学意义(P>0.05)。但相较于对照组,研究组放射性食管炎与血小板减少的发生几率明显更低(P<0.05)。免疫功能方面,研究组治疗后CD8⁺ T细胞、NK细胞比例及IL-2、IFN-γ、TNF-α水平高于对照组(P<0.05),CD4⁺/CD8⁺比值低于对照组(P<0.05)。研究组的手术时间、术后ICU停留时间、术后胸腔引流量、术后引流管留置时间及术后住院时间均显著短于对照组,淋巴结清扫总数多于对照组(P<0.05)。研究组在术后各类并发症的整体发生率上低于对照组(P<0.05)。结论: nCIT在减少放疗相关毒性、促进术后康复以及减少并发症发生方面展现出优势,可能成为放疗耐受性差或需快速康复患者的优选方案。

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关键词 ：食管鳞状细胞癌, 新辅助放化疗, 新辅助免疫联合化疗, 术后恢复, 不良反应

Abstract：Objective: To study the efficacy and safety profiles of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant immunochemotherapy (nCIT) among patients diagnosed with locally advanced esophageal squamous cell carcinoma (ESCC) and their impact on postoperative recovery. Methods: A total of 165 patients with locally advanced ESCC admitted to The Second Affiliated Hospital of Air Force Medical University from January 2021 to December 2023 were retrospectively analyzed. In line with the neoadjuvant treatment plan, the patients were separated into the control group (administered nCRT, with a sample size of 62) and the study group (receiving nCIT, with 103 participants). The postoperative pathological remission rate, incidence of adverse events, changes in immune function, perioperative indicators and incidence of postoperative complications were compared between the two groups. Results: The R0 resection rate, pathological complete response (pCR) rate, and major pathological response (MPR) rate did not show significant differences between the two groups (P>0.05). However, the occurrence rate of radiation esophagitis and thrombocytopenia in the study group was remarkably reduced compared with the control group (P<0.05). Regarding immune function, the percentages of CD8⁺ T cells and NK cells, along with the levels of IL-2, IFN-γ and TNF-α, were elevated in the study group relative to the control group (P<0.05), and the CD4, Shaanxi/CD8, Shaanxi ratio was decreased compared to the control group (P<0.05). Compared with the control group, the operation time, postoperative ICU stay time, postoperative chest drainage volume, postoperative drainage tube indwelling time and postoperative hospital stay were all shorter in the study group. Additionally, the total quantity of lymph nodes dissected was higher in the study group than in the control group (P<0.05). The overall occurrence rate of postoperative complications in the study group was lower than that in the control group (P<0.05). Conclusion: nCIT has advantages in reducing radiotherapy-related toxicity, improving postoperative recovery and reducing complications, and may be an optimal regimen for patients with poor tolerance to radiotherapy or those who need rapid recovery after surgery.

Key words： Esophageal squamous cell carcinoma Neoadjuvant chemoradiotherapy Neoadjuvant chemo-immunotherapy Postoperative recovery Adverse reaction

基金资助:陕西省重点研发计划项目,(编号:2022SF-061)

通讯作者: 王文辰

引用本文:

姜飞娥, 刘倩, 徐硕男, 孙启昊, 王文辰. 新辅助免疫联合化疗治疗在局部进展期食管鳞状细胞癌手术患者中的临床疗效分析[J]. 河北医学, 2025, 31(11): 1930-1936.
JIANG Feie, LIU Qian, XU Shuonan, et al. Clinical Efficacy Analysis of Neoadjuvant Immunotherapy Combined with Chemotherapy in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma Undergoing Surgery. HeBei Med, 2025, 31(11): 1930-1936.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.11.029 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I11/1930

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