Title : Evaluation of survival prognostic factors in different treatment modalities for locally advanced unresectable esophageal squamous cell carcinoma
Abstract:
Background: Esophageal cancer, particularly esophageal squamous cell carcinoma (ESCC), remains a leading cause of cancer-related mortality worldwide. This study investigates the impact of different treatment modalities, namely concurrent chemoradiotherapy (CCRT), chemoimmunotherapy (CIT), and induction chemoimmunotherapy followed by chemoradiotherapy or radiotherapy (CIT+CRT/RT), on survival outcomes in patients with locally advanced unresectable ESCC.
Methods: We conducted a retrospective cohort analysis of 213 ESCC patients treated at the Fourth Affiliated Hospital of China Medical University and Liaoning Cancer Hospital from April 2015 to September 2023. Patients were categorized into three groups: CCRT, CIT, and CIT+CRT/RT. The study aimed to compare overall survival (OS), progression-free survival (PFS), and other treatment efficacy indicators. Data were analyzed using Kaplan-Meier and Cox regression models.
Results: The median OS for the CIT+CRT/RT group (28 months) was significantly higher than that of the CCRT group (20 months) and the CIT group (24 months), with the difference between CIT+CRT/RT and CCRT groups reaching statistical significance (P = 0.032). However, the 1-year OS rates did not show significant differences between the groups (P = 0.082). The 2-year OS rate was significantly better in the CIT+CRT/RT group?33.3%?compared to the CIT group?9.0%? (P < 0.001). PFS at 2 years was also significantly better for the CIT+CRT/RT group compared to CIT (P = 0.001). Factors such as age and performance status were found to be independent prognostic factors.
Conclusion: Our study demonstrates that the CIT+CRT/RT regimen provides a significant survival advantage in patients with locally advanced unresectable ESCC compared to CCRT and CIT. These findings highlight the importance of combined treatment modalities in improving patient outcomes, although the influence of radiotherapy dose remains minimal. Further research is needed to refine treatment strategies and assess long-term survival benefits.
