Survival advantage of first-line chemoimmunotherapy combined with radiotherapy for advanced esophageal squamous cell carcinoma: A propensity score matching analysis
10.3760/cma.j.cn112271-20241126-00457
- VernacularTitle:晚期食管鳞癌一线化免联合放射治疗的生存优势：一项评分匹配分析
- Author:
Peixin FENG
1
;
Qing HOU
;
Ningning YAO
;
Wenjuan ZHANG
;
Bochen SUN
;
Wenxia NIU
;
Anqi ZHAO
;
Wenlu CHEN
;
Baixue WU
;
Yuying ZHOU
;
Yiwen ZHANG
;
Yu LIANG
;
Xin CAO
;
Wei BAI
;
Jianting LIU
;
Shuangping ZHANG
;
Jianzhong CAO
Author Information
1. 山西医科大学附属肿瘤医院放射治疗科，太原 030013
- Publication Type:Journal Article
- Keywords:
Esophageal cancer;
Immunotherapy;
Radiotherapy;
Propensity score matching
- From:
Chinese Journal of Radiological Medicine and Protection
2025;45(8):766-773
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of radiotherapy in patients with advanced esophageal cancer receiving first-line chemoimmunotherapy.Methods:A retrospective analysis was conducted on the data of 137 patients with Stage Ⅳ esophageal squamous cell carcinoma (ESCC) treated at our hospital from January 2018 to May 2023. These patients were divided into two groups: a group treated with first-line chemoimmunotherapy combined with radiotherapy (chemoimmunotherapy + radiotherapy group, n = 43) and a group treated with only chemoimmunotherapy ( n = 94). Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between the groups. With overall survival (OS) and progression-free survival (PFS) as study endpoints, the survival data were analyzed using the Kaplan-Meier method, the log-rank test, and the Cox regression method. Results:Before calibration, the chemoimmunotherapy + radiotherapy group significantly outperformed the sole chemoimmunotherapy group in median PFS (13.6 months vs. 7.0 months; HR: 0.501, 95% CI: 0.309-0.811, P = 0.005). After calibration using the COX proportional-hazards model for age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, smoking history, T/N/M stage, and tumor location, the chemoimmunotherapy + radiotherapy group still had significant advantages in PFS (14.7 months vs. 7.0 months; HR: 0.441, 95% CI: 0.261-0.745, P = 0.002). IPTW analysis further confirmed this trend (13.9 months vs. 7.0 months; HR: 0.492, 95% CI: 0.304-0.795, P < 0.001). Specifically, the median OS of the chemoimmunotherapy + radiotherapy group demonstrated significant improvement in all analyses: pre-calibration (29.5 months vs. 18.0 months; HR: 0.507, 95% CI: 0.297-0.867, P = 0.013), after calibration using the Cox model (27.5 months vs. 16.7 months; HR: 0.470, 95% CI: 0.266-0.830, P = 0.009), and after calibration using IPTW (29.5 months vs. 16.9 months; HR: 0.448, 95% CI: 0.262-0.764, P < 0.001). Conclusions:The combination of radiotherapy and first-line chemoimmunotherapy can significantly improve survival outcomes of patients with advanced ESCC, suggesting its potential as a standard treatment strategy.
