Prognostic value of recurrence pattern in locally advanced esophageal squamous cell carcinoma: Results from the phase III trial NEOCRTEC5010

Meta-Analysis of Recurrence-Free Survival or Disease-Free Survival as a Potential Surrogate Endpoint for Overall Survival in Esophageal Cancer Trials

BACKGROUND

Cancer trials increasingly use surrogate endpoints, but it is unclear how well recurrence-free survival (RFS) or disease-free survival (DFS) specifically predict overall survival (OS) in resectable esophageal cancer (EC).

METHODS

A systematic literature review identified trials with RFS/DFS and OS endpoints. A meta-analysis assessed RFS/DFS as surrogates for OS, estimating pooled hazard ratios (HRs) from trial HRs. Forest plots and heterogeneity tests showed effect sizes and pooled estimates. Unweighted linear regression and weighted sensitivity analysis estimated the correlation between OS and RFS/DFS, producing a regression plot.

RESULTS

Of 975 articles identified, 11 met the criteria. The pooled HR for OS and RFS/DFS was 0.90 and 0.87, respectively. The primary analysis showed a strong Pearson correlation between RFS/DFS and OS (ρ = 0.89, p < 0.001).

CONCLUSION

Subject to known methodological limits, RFS/DFS was demonstrated to be a potentially suitable surrogate endpoint for OS in resectable EC.

Qizhu Yuling prescription in the prevention of postoperative metastasis and recurrence of esophagus cancer: study protocol for a randomized, double-blind, placebo-controlled, multicenter clinical trial

Background

Esophageal cancer (EC) is a malignant tumor with a high recurrence and metastasis rate and poor prognosis. In 2024, China ranked first in the world in terms of new EC cases and deaths. Surgery is the main treatment method for EC, but the clinical difficulty is how to prevent recurrence and metastasis after surgery. Traditional Chinese medicine as a complementary therapy has played an important role in this regard. Preclinical studies have confirmed that Qizhu Yuling Prescription (QZYLP) has anticancer effects, reduces treatment side effects, and improves quality of life, except for the lack of long-term prognostic results. Therefore, this study aims to investigate whether QZYLP can reduce the recurrence and metastasis rates of EC after surgery, improve disease-free survival (DFS), prolong overall survival, and observe the safety of the drug.

Methods

This study is a multicenter, randomized, double-blind, placebo-controlled clinical trial. It seeks to enroll 310 patients from 10 hospitals who have completed adjuvant therapy following R0 surgery for esophageal squamous cell carcinoma without recurrent metastasis. Using a center-randomized design, participants will be assigned to the control group (n=155, receiving placebo treatment) or experimental group (n=155, receiving QZYLP granules treatment). Treatment will last for 6 months, with follow-up every 3 months after the final treatment or endpoint event, continuing for up to 3 years postoperatively. The primary outcome measured is DFS at 1 year postoperatively. Secondary outcomes included indicators related to prognosis, fat distribution, peripheral blood inflammation, tumor markers, and quality of life scales.

Discussion

This study aims to further clarify the efficacy and safety of QZYLP in preventing postoperative recurrence and metastasis of EC, and to explore the mechanism of action. The results of this study will provide high-quality evidence for the participation of TCM in the comprehensive treatment program of EC, and improve the precise diagnosis and treatment system of TCM in EC.

Clinical trial registration

ClinicalTrials.gov, identifier NCT05626309.

Postoperative adjuvant immunotherapy for pathological stage II-IVa esophageal squamous cell carcinoma after radical surgery does not improve disease-free recurrence rates

Background/objectives

Postoperative adjuvant therapy for esophageal squamous cell carcinoma (ESCC) primarily includes chemotherapy and chemoradiotherapy. The survival benefits of postoperative adjuvant therapy for R0-resected ESCC remain controversial. Immunotherapy is being gradually applied perioperatively for esophageal cancer, but the efficacy of postoperative immunotherapy in ESCC is unclear. This study aimed to evaluate the effectiveness of postoperative immunotherapy for esophageal cancer. Toward this goal, we explored the differences between postoperative immunotherapy combined with chemotherapy and postoperative adjuvant chemotherapy alone.

Methods

This retrospective study evaluated patients who underwent radical surgery for esophageal cancer at Gaozhou People's Hospital between January 2020 and August 2022 and received postoperative adjuvant therapy. Patients were divided into two groups according to the adjuvant treatment regimens: postoperative adjuvant chemotherapy (aCT) and postoperative adjuvant immunotherapy combined with chemotherapy (aICT) groups. Data on baseline characteristics, surgical-related indicators, adverse event rates during adjuvant therapy, and 2-year postoperative follow-up were collected for both groups.

Results

A total of 76 patients were included: 36 and 40 patients in the aICT and aCT groups, respectively. There were no significant differences in baseline data between the two groups. During the adjuvant treatment period, the incidence of hypothyroidism was significantly higher in the aICT group than in the aCT group (25.0% vs. 2.5%, p = 0.007). During the 2-year follow-up, local and recurrence rates were 17.5 and 12.5% in the aCT group and 13.9 and 5.6% in the aICT group, respectively, showing no significant difference between the two groups (p = 0.489).

Conclusion

For patients with pathologically confirmed locally advanced ESCC after surgery, postoperative immunotherapy did not confer better disease-free recurrence rates compared to postoperative adjuvant therapy. Nonetheless, with research advancements, the role of immunotherapy in the treatment of ESCC is likely to expand, offering new hope for these patients.

Comparison of neoadjuvant chemoimmunotherapy and neoadjuvant chemotherapy for resectable esophageal squamous cell carcinoma: a retrospective study with 3-year survival analysis

BACKGROUND

Neoadjuvant chemoimmunotherapy (nCIT) for locally advanced esophageal squamous cell cancer (ESCC) has shown short-term benefits, but long-term survival outcomes are unclear. This study compares nCIT and neoadjuvant chemotherapy (nCT) in resectable ESCC.

PATIENTS AND METHODS

A retrospective analysis was conducted on ESCC patients who underwent nCT or nCIT followed by esophagectomy. Propensity score matching (PSM) with a caliper of 0.02 was employed to minimize bias. The primary endpoints included disease-free survival (DFS) and overall survival (OS).

RESULTS

A total of 131 comparable pairs of ESCC patients receiving nCT and nCIT were selected for the final analysis. The nCIT had higher rates of pathological complete response (pCR) and major pathological response (mPR) compared to nCT. Additionally, nCIT led to significant tumor down-staging, higher rates of R0 resection, and increased lymph node clearance during surgery. Patients who received nCIT exhibited improved disease-free survival (DFS) and overall survival (OS) at the 3-year follow-up. The incidence of distant and mixed relapses was lower in the nCIT group compared to the nCT group. However, the risk of locoregional relapse was comparable between the two groups. Subgroup analyses showed that the benefits of nCIT were generally observed across most patient subgroups. Interestingly, in patients without pCR or mPR, nCIT still demonstrated better survival benefits than nCT.

CONCLUSION

nCIT demonstrated superior pathological response rates and improved 3-year DFS and OS compared to nCT alone in locally advanced ESCC, but long-term survival validation is needed.

Recurrence timing and patterns incorporating lymph node status after neoadjuvant chemoradiotherapy plus esophagectomy for esophageal squamous cell carcinoma

Purpose

About 40% of esophageal squamous cell carcinoma (ESCC) patients experienced recurrence after neoadjuvant chemoradiotherapy (nCRT) plus esophagectomy. While limited information was available on recurrence risk stratification in ESCC after neoadjuvant treatment. Our previous study showed ypN status was a reliable tool to differentiate and predict the prognosis in the recurrent population. Here, we evaluated recurrence timing and patterns in ESCC patients, taking into consideration lymph node status after nCRT.

Materials and methods

A total of 309 ESCC patients treated with nCRT plus esophagectomy between 2018 and 2021 were enrolled in this observational cohort study. Lymph node status was recorded by the pathologist according to the surgical specimens. We retrospectively investigated the timing and patterns of recurrence and the prognoses in ESCC patients, taking into consideration lymph node status after nCRT.

Results

After nCRT plus surgery in ESCC patients, lymph node metastasis was associated with unfavorable clinicopathological factors and high risks of recurrence. In the recurrent subgroup, ypN+ patients experienced earlier recurrence, especially for locoregional recurrence within the first year. Moreover, ypN+ patients had poorer prognosis. However, the recurrence patterns in the ypN- and ypN+ groups were similar. Besides, there were no significant differences in surgery to recurrence, recurrence to death, or overall survival among patients with locoregional or distant recurrence for overall patients and within ypN- or ypN+ groups.

Conclusions

Lymph node metastasis was correlated with unfavorable clinicopathological factors and high risks of recurrence. Despite a similar recurrence pattern in the recurrent subgroup between the ypN- and ypN+ groups, ypN+ patients exhibited earlier recurrence and a worse prognosis.

Prognostic Factors and Outcomes in Elderly Esophagectomy Patients with Esophageal Cancer

BACKGROUND

Choosing the appropriate treatment for elderly patients with esophageal cancer remains a contentious issue. While surgery is still a valid option, we aimed to identify predictors and outcomes in elderly esophagectomy patients with esophageal cancer.

PATIENTS AND METHODS

We analyzed characteristics, surgical outcomes, survival rates, cause-specific mortality, and recurrence in 120 patients with stage I-IV esophageal cancer. Univariate and multivariate analyses were used to identify risk factors for event-free survival (EFS) and overall survival (OS).

RESULTS

The median follow-up period was 31 months, with 5-year overall survival (OS) and event-free survival (EFS) rates standing at 45.2% and 41.5%, respectively. Notably, lower body mass index (BMI ≤ 22 kg/m2) and reduced preoperative albumin levels (pre-ALB < 40 g/L) led to a significant decrease in OS rates. Postoperative pulmonary complications resulted in higher in-hospital and 90-day mortality rates. After about 31 months post-surgery, the rate of cancer-specific deaths stabilized. The most common sites for distant metastasis were the lungs, supraclavicular lymph nodes, liver, and bone. The study identified lower BMI, lower pre-ALB levels, and postoperative pulmonary complications as independent risk factors for poorer EFS and OS outcomes.

CONCLUSIONS

Esophagectomy remains a safe and feasible treatment for elderly patients, though the prevention of postoperative pulmonary infection is crucial. Factors such as lower BMI, lower pre-ALB levels, advanced tumor stage, postoperative pulmonary complications, and certain treatment modalities significantly influence the outcomes in elderly esophagectomy patients. These findings provide critical insights into the characteristics and outcomes of this patient population.

Radiotherapy combined with immune checkpoint inhibitors in locally advanced/metastatic esophageal squamous cell carcinoma: clinical trials, efficacy and future directions

Esophageal squamous cell carcinoma (ESCC) is a common malignancy worldwide and often diagnosed at advanced stages with poor prognosis. Combination of radiotherapy and immunotherapy seems to be a promising approach for treating ESCC. This comprehensive review article summarizes the current state of combination of radiotherapy and immunotherapy in locally advanced/metastatic ESCC, delineates the clinical trials that merit attention, and outlines unresolved issues and future research directions in this field. The clinical trial findings suggest that radio-immunotherapy combination may improve tumor response and overall survival with manageable side effects, highlighting the importance of patient selection and the necessity for further research to optimize treatment strategies. Issues such as irradiation dosage, fractionation regimen, irradiation site and technique of radiotherapy, as well as the timing, sequence and duration of combination therapy will all affect treatment outcomes, justifying further in-depth investigation.