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Comparative analysis of immunochemotherapy with versus without radiation therapy for stage IVB esophageal squamous cell carcinoma confined to non-regional nodal metastases: a multicenter propensity score matching study

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机构: [1]Fudan Univ, Shanghai Canc Ctr, Dept Radiat Oncol, 270 Dongan Rd, Shanghai 200032, Peoples R China [2]Fudan Univ, Shanghai Med Coll, Dept Oncol, Shanghai 200032, Peoples R China [3]Shanghai Clin Res Ctr Radiat Oncol, Shanghai Key Lab Radiat Oncol, Shanghai 200032, Peoples R China [4]Fujian Med Univ, Fujian Canc Hosp, Clin Oncol Sch, Dept Radiat Oncol, Fuzhou 350014, Peoples R China [5]Hebei Med Univ, Hosp 4, RT Dept, Shijiazhuang 050011, Peoples R China [6]Nanjing Med Univ, Jiangsu Canc Hosp, Jiangsu Inst Canc Res, Dept Radiotherapy,Affiliated Canc Hosp, Nanjing 210000, Peoples R China [7]Huaian First Peoples Hosp, Dept Radiat Oncol, Huaian 223300, Peoples R China [8]Northern Jiangsu Peoples Hosp, Dept Oncol, Yangzhou 225001, Peoples R China [9]Chinese Acad Med Sci & Peking Union Med Coll, Natl Canc Ctr, Dept Radiat Oncol, Natl Clin Res Ctr Canc ,Canc Hosp, Beijing 100021, Peoples R China [10]Zhejiang Canc Hosp, Dept Radiat Oncol, Hangzhou 310006, Peoples R China [11]Cent South Univ, Xiangya Hosp, Dept Oncol, Changsha 410008, Peoples R China [12]Nanchang Univ, Affiliated Hosp 2, Dept Oncol, Nanchang 330006, Jiangxi, Peoples R China [13]Anhui 2 Prov Peoples Hosp, Dept Radiat Oncol, Hefei 230012, Peoples R China [14]Zhengzhou Univ, Affiliated Canc Hosp, Dept Radiat Oncol, Zhengzhou 450052, Peoples R China [15]Univ Elect Sci & Technol China, Sichuan Canc Hosp & Inst, Sichuan Clin Res Ctr Canc, Sichuan Canc Ctr,Dept Radiat Oncol,Affiliated Canc, Chengdu 610041, Sichuan, Peoples R China [16]Jiangxi Prov Canc Hosp, Dept Radiat Oncol, Nanchang 330029, Peoples R China [17]Air Force Med Univ, Xijing Hosp, Dept Radiat Oncol, Xian 710032, Peoples R China [18]Wuhan Univ, Zhongnan Hosp, Dept Pulm Oncol, Wuhan 430071, Peoples R China [19]Xiamen Univ, Affiliated Hosp 1, Dept Radiotherapy, Xiamen 361009, Peoples R China [20]Wenzhou Med Univ, Affiliated Hosp 2, Dept Radiat & Med Oncol, Wenzhou 325027, Zhejiang, Peoples R China [21]Wenzhou Med Univ, Yuying Childrens Hosp, Wenzhou 325027, Zhejiang, Peoples R China [22]Nanchang Univ, Affiliated Hosp 1, Dept Oncol, Nanchang 330006, Peoples R China [23]Nanjing Med Univ, Nantong Univ, Affiliated Hosp 6, Yancheng Sch Clin Med ,Yancheng Peoples Hosp 3,Dep, Yancheng 224002, Peoples R China [24]Chinese Acad Med Sci & Peking Union Med Coll, Canc Hosp, Natl Clin Res Ctr Canc, Dept Radiat Oncol,Natl Canc Ctr, 113 Baohe Rd, Shenzhen 518116, Peoples R China [25]Chinese Acad Med Sci & Peking Union Med Coll, Shenzhen Hosp, 113 Baohe Rd, Shenzhen 518116, Peoples R China
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关键词: Esophageal cancer PD-1 inhibitor Squamous cell Radiation therapy

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Background The survival benefit of adding radiotherapy (RT) to immunochemotherapy (ICT) in patients with stage IVB esophageal squamous cell carcinoma (ESCC) confined to non-regional lymph node metastases remains uncertain. This study evaluated whether RT combined with first-line PD-1 inhibitor-based ICT improves outcomes. Methods In this multicenter retrospective cohort study, 343 patients with stage IVB ESCC (non-regional nodal metastases only; AJCC 8th edition) treated with PD-1 inhibitors plus chemotherapy between 2019 and 2021 were analyzed. Patients were stratified into RT (ICT + RT, n = 181) and non-RT (ICT alone, n = 162) groups. Propensity score matching (PSM) balanced baseline characteristics (age, sex, metastatic sites, etc.), yielding 125 matched pairs. RT (> 40 Gy to primary lesions) was delivered via IMRT/VMAT (median dose, 50.4 Gy). Primary endpoints were overall survival (OS) and progression-free survival (PFS). Results After PSM, the RT group showed significantly longer median OS (22.3 vs 14.9 months; HR 0.51, 95% CI 0.37-0.71; P < 0.001) and PFS (14.0 vs 6.1 months; HR 0.57, 95% CI 0.42-0.77; P < 0.001) versus non-RT. Sequential RT (post-induction ICT) conferred maximal OS benefit (median OS 29.2 vs 12.1 months; HR 0.38, P < 0.001). Exploratory analysis indicated that the most significant survival benefit was observed in patients receiving sequential RT targeting the primary tumor with or without metastatic nodes, rather than metastasis-directed RT alone. Grade 3-5 treatment-related adverse events were comparable between groups; however, RT was associated with significantly higher rates of grade 3-4 lymphopenia (15.2% vs 4.0%, p = 0.004) and esophagitis (11.2% vs 0%, p < 0.001). Conclusion Adding RT to first-line ICT improves survival in stage IVB ESCC with non-regional nodal metastases, particularly when delivered sequentially to the primary tumor.

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大类 | 3 区 医学
小类 | 3 区 免疫学 3 区 肿瘤学
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大类 | 3 区 医学
小类 | 3 区 免疫学 3 区 肿瘤学
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Q1 IMMUNOLOGY Q1 ONCOLOGY
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Q1 IMMUNOLOGY Q1 ONCOLOGY

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第一作者机构: [1]Fudan Univ, Shanghai Canc Ctr, Dept Radiat Oncol, 270 Dongan Rd, Shanghai 200032, Peoples R China [2]Fudan Univ, Shanghai Med Coll, Dept Oncol, Shanghai 200032, Peoples R China [3]Shanghai Clin Res Ctr Radiat Oncol, Shanghai Key Lab Radiat Oncol, Shanghai 200032, Peoples R China
通讯作者:
通讯机构: [1]Fudan Univ, Shanghai Canc Ctr, Dept Radiat Oncol, 270 Dongan Rd, Shanghai 200032, Peoples R China [2]Fudan Univ, Shanghai Med Coll, Dept Oncol, Shanghai 200032, Peoples R China [3]Shanghai Clin Res Ctr Radiat Oncol, Shanghai Key Lab Radiat Oncol, Shanghai 200032, Peoples R China [24]Chinese Acad Med Sci & Peking Union Med Coll, Canc Hosp, Natl Clin Res Ctr Canc, Dept Radiat Oncol,Natl Canc Ctr, 113 Baohe Rd, Shenzhen 518116, Peoples R China [25]Chinese Acad Med Sci & Peking Union Med Coll, Shenzhen Hosp, 113 Baohe Rd, Shenzhen 518116, Peoples R China
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