Observation On The Efficacy Of Chemotherapy Combined With Immunotherapy And Chemotherapy Alone For Recurrent And Metastatic Esophageal Cancer After Radiotherapy (Chemotherapy)

Objective:By including chemotherapy combined with immunotherapy and chemotherapy alone in patients with recurrent and metastatic esophageal cancer after radiotherapy(chemotherapy),the basic clinical characteristics,short-term efficacy,long-term efficacy and adverse reactions were observed and compared to determine the feasibility and value of immune intervention in patients with recurrent and metastatic esophageal cancer after radiotherapy(chemotherapy),and the influencing factors of prognosis were analyzed.To provide reference for individual selection of secondary treatment.Methods:Retrospective analysis was performed on patients with esophageal carcinoma who underwent radiotherapy(chemotherapy)and developed local regional recurrence,lymph node metastasis and distant metastasis after receiving radical radiotherapy from January 2019 to December 2021 in Shanxi Cancer Hospital and Shanxi Bethune Hospital.A total of 104 patients who received chemotherapy combined with immunotherapy and chemotherapy alone meeting the inclusion criteria were screened.Retrospective analysis was performed on the clinical characteristics,short-term efficacy,long-term efficacy and occurrence of adverse reactions of patients receiving chemotherapy combined with immunotherapy or chemotherapy alone as two further treatment modes.The prognostic factors that may affect secondary treatment,such as sex,age,lesion site,length of lesion at initial treatment,TNM stage at initial treatment,first treatment plan,first radiotherapy mode,recurrence interval,secondary treatment plan and KPS score,were analyzed.Statistical analysis was performed using SPSS 26.0 software package,statistical data were expressed as cases or percentage,χ~2test was used for comparison between groups,Kaplan-Meier method was used for univariate analysis,survival rate was calculated and survival curve was plotted.Survival differences between groups were tested by Log-rank,and Cox proportional hazard regression model was used for multivariate analysis.P<0.05 was statistically significant.Survival time after recurrence or metastasis is calculated from the date of diagnosis of local recurrence or metastasis.The last follow-up time was taken as the time of death.Results:The follow-up period ended December 31,2021,and 6 cases were lost to follow-up,with a follow-up rate of 94%.At the end of follow-up on 31 December2021,there were four survivors.1.Basic clinical data:A total of 104 patients meeting the inclusion criteria were included,including 58 males and 46 females;The median age of recurrence was 62years,ranging from 49 to 79 years.Lesion location:28 cases of cervical segment,34cases of upper thoracic segment,28 cases of middle thoracic segment,14 cases of lower thoracic segment.56 patients with lesion length≤5cm and 48 patients with lesion length>5cm before first radiotherapy;TNM staging of esophageal cancer was performed by AJCC 7th edition before first radiotherapy:6 cases of stageⅠ,44 cases of stageⅡ,54 cases of stageⅢ;The first treatment was radiotherapy alone in 24 cases and chemoradiotherapy in 80 cases.The first radiotherapy was three dimensional conformal radiotherapy in 35 cases and intensity modulated radiotherapy in 69 cases.The interval of recurrence ranged from 7 to 103 months,and the median time was 18months,among which the interval of recurrence was>6 months,≤12 months in 32cases,>12 months,≤24 months in 56 cases,>24 months in 16 cases.Retreatment included 38 patients in the chemotherapy alone group and 66 patients in the chemotherapy combined immunotherapy group.There were 36 patients with KPS score 70,44 patients with 80,and 24 patients with 90.2.Adverse reactions:The chemotherapy combined with immunotherapy group(n=66)was well tolerated,and the incidence of adverse reactions and grade≥3adverse reactions was higher than that of chemotherapy alone group(n=38),but the differences were not statistically significant.3.Short-term efficacy:The objective remission rate of chemotherapy combined with immunotherapy group(n=66)was higher than that of chemotherapy alone group(n=38),and there was a statistical difference in the objective remission rate between the two groups(P<0.05).4.Long-term efficacy:The 1-,2-and 3-year survival rates were 42.3%,21.2%and 7.7%,respectively,with a median survival time of 11.6 months in the whole group of patients(n=104).The 1-,2-and 3-year survival rates in the chemotherapy group(38 cases)and the chemotherapy combined immunotherapy group(66 cases)after further treatment were 36.8%,10.5%,0 and 45.5%,27.3%,12.1%,respectively.The median survival time was 9 and 12 months,respectively.The difference is statistically significant.(χ2=11.717,P=0.001)5.Univariate analysis:Age(P=0.003),the first treatment(P=0.003),the interval between the first treatment and relapse(P=0.008),the treatment regimen after relapse(P=0.001),and KPS score(P=0.044)were the factors affecting the survival and prognosis of patients.However,gender(P=0.319),lesion site(P=0.704),lesion length(P=0.661),first clinical stage(P=0.138),and radiation pattern for the first time(P=0.664)were not correlated with survival prognosis.6.Multivariate analysis:Cox multivariate analysis showed that patients’age(P=0.019),initial treatment regimen(P=0.005),relapse interval(P=0.042),and post-relapse treatment regimen(P=0.001)were independent factors affecting patients’survival after further treatment.Conclusion:1.For patients with recurrent metastatic esophageal cancer after radiotherapy(chemotherapy),chemotherapy combined with immunotherapy during subsequent treatment has benefits in terms of prolonged survival and improve-d objective response rate compared with chemotherapy alone.2.For patients with recurrent and metastatic esophageal cancer after radiotherapy(chemotherapy),chemotherapy combined with immunotherapy in secondary treatment is higher than chemotherapy alone,but most of the adverse reactions are grade 1-2,which can be tolerated by patients.3.Age,first treatment regimen,recurrence interval,and treatment modality after recurrence are indivisible profiler factors influencing the survival of patients with recurrent metastatic esophageal cancer after radiotherapy(chemotherapy)and re-course treatment.4.Clinically,patients with recurrent metastatic esophageal cancer after radiotherapy(chemotherapy)should fully evaluate the general physical condition,the status of recurrent and metastatic lesions,and the length of relapse interval for patients to develop an individualized treatment plan.