| BackgroundChina is the country with the highest incidence of esophageal squamous cell carcinoma（ESCC）.In 2020,there were 324,000 new ESCC cases in China,accounting for about 50%of the total cases in the world.However,due to the lack of regular screening and limited medical conditions,many ESCC patients were diagnosed at later stage and could not be operated.Currently,concurrent radiochemotherapy（CRT）is the first-line treatment for unresectable ESCC patients,but the therapeutic effect is not satisfactory,and the 3-year survival rate is only 20-30%.Therefore,increasing clinical trials are actively seeking better treatments,e.g.,induction chemotherapy plus concurrent chemoradiotherapy（IC+CRT）.Circulating tumor cells（CTCs）are tumor cells that lose their adhesion ability and infiltrate the peripheral blood due to spontaneous or/and surgical contamination.Continuous positive CTCs are likely to develop metastases,while induction chemotherapy can eliminate micrometastases in peripheral blood and reduce the risk of metastasis after concurrent chemoradotherapy.Therefore,patients with CTCs（+）to choose the IC+CRT treatment is more reasonable,but the effect remains to be verified.The purpose of this study is to compare the efficacy and survival time of locally advanced ESCC patients treated with IC+CRT and CRT by detecting CTCs in peripheral blood.MethodsA total of 124 ESCC patients who received concurrent radiochemotherapy in Chaohu Hospital of Anhui Medical University from January 2016 to January2019 were enrolled.CTCs was measured for all ESCC patients before treatment.According to whether the patients received induction chemotherapy before concurrent radiochemotherapy,they were divided into IC+CRT group（n=62）and CRT group（n=62）.All patients in IC+CRT group received 2-4 cycles of induction chemotherapy before concurrent radiochemotherapy.General data,short-term effect and long-term effect of the patients were collected.The related factors between CTCs and esophageal cancer were analyzed,the effects of CTCs on the short-term and long-term efficacy of the two groups were compared,and the influencing factors of the induced chemotherapy efficacy were analyzed by stratification.ResultsAmong the 124 patients,64（51.6%）were CTCs（+）and 60（48.4%）were CTCs（-）.The positive rate of CTCs was related to tumor invasion（T）（χ~2=5.827,P=0.016）,lymph node metastasis（N）（χ~2=16.521,P<0.001）and pathological stage（χ~2=11.888,P=0.001）.The distant metastasis rate（χ~2=4.528,P=0.033）and local recurrence rate（χ~2=4.205,P=0.040）of esophageal cancer after treatment were both related to CTCs index.In the short-term efficacy,the objective remission rate（ORR）of the IC+CRT group was 72.6%.The ORR of CRT group was 58.1%,and there was no significant difference between the two groups（χ~2=2.884,P=0.089）.In the CTCs（+）subgroup,the ORR of the IC+CRT group and the CRT group was 72.7%and 48.4%,respectively;and the difference was statistically significant（χ~2=3.978,P=0.046）.In the CTCs（-）subgroup,the ORR of the IC+CRT group and the CRT group was 72.4%and 67.7%,respectively;and the difference was not statistically significant（χ~2=0.156,P=0.693）.In the long-term effect,the median survival time（MST）of the IC+CRT group and the CRT group was 23 months and 15 months,respectively;and the MST of the IC+CRT group was higher than that of the CRT group（χ~2=5.286,P=0.021）,and the progression-free survival（PFS）of the IC+CRT group was also higher than that of the CRT group（18 months VS 11 months,χ~2=4.168,P=0.041）.According to whether CTCs is positive or not,patients were devided into the CTCs（+）and CTCs（+）subgroups.In the CTCs（+）subgroup,the overall survival（OS）of the IC+CRT group was higher than that of the CRT group（χ~2=7.045,P=0.008）,the MST was 21 months in the IC+CRT group and 12 months in the CRT group.The MST of the both groups was 24 months in the CTCs（-）subgroup,there was no significant difference between the two groups（χ~2=1.140,P=0.286）.According to the stratified analysis of the long-term efficacy,we found that the OS in the subgroups of induced chemotherapy,such as pathological grade G1-2（P=0.014）,tumor diameter<5cm（P=0.007）,weekly synchronous chemotherapy alone（P=0.018）and effective induction chemotherapy（P=0.001）,were better than those without induction chemotherapy.Cox multivariate regression analysis showed that tumor stage（HR=1.844,P=0.019）and CTCs（HR=1.666,P=0.012）were risk factors for OS,while radiotherapy and chemotherapy mode（HR=0.617,P=0.014）was a protective factor for OS.Conclusion1.CTCs is related to the development and prognosis of esophageal carcinoma.2.Induction chemotherapy improves the efficacy and survival time of patients with locally advanced esophageal carcinoma,and the benefits are more advantageous in the CTC（+）group,the effective induction chemotherapy group,the pathological grade G1-2 group,the tumor diameter<5cm group,the weekly synchronous chemotherapy with single drug group.3.CTCs provide a new diagnostic and therapeutic target for patients with locally advanced esophageal carcinoma to chose the radiotherapy and chemotherapy mode,which is worthy of further confirmation using a prospective large sample size study. |
PDF Full Text Request