在新辅助化疗的基础上增加免疫治疗是否会增加胃食管交界处腺癌的术后发病率？一项倾向评分匹配的研究
Does adding immunotherapy to neoadjuvant chemotherapy increase postoperative morbidity in gastroesophageal junction adenocarcinoma? A propensity score-matched study.
摘要(中文译文)
关键性试验已确立新辅助免疫治疗联合化疗（NICT）在胃癌和食管癌中的手术可行性，但针对胃食管结合部（GEJ）这一狭窄解剖区域的特异性数据仍然有限。本研究旨在比较接受NICT与仅接受新辅助化疗（NCT）患者的术后并发症发生率。本单中心回顾性队列研究连续纳入局部晚期GEJ腺癌（Siewert II/III型）患者，这些患者在接受NICT（n=140）或单纯新辅助化疗（NCT，n=260）后行根治性切除术。倾向性评分匹配（1:1）平衡了基线特征，包括dMMR/MSI-H状态和手术方式，最终获得120对匹配病例。主要结局为主要并发症（Clavien-Dindo ≥III级）。次要结局包括特定手术并发症、免疫相关不良事件（irAEs）及手术间隔时间。匹配后，NICT与更优的主要病理缓解相关（58.3% vs. 45.8%；p=0.028）。主要终点在NICT与NCT队列间无显著差异（25.8% vs. 22.5%；p=0.538）。关键在于，未观察到特定技术性并发症的差异，包括吻合口漏（11.7% vs. 10.0%）、管状胃失败（3.3% vs. 2.5%）或肺部事件。NICT队列中13.3%发生irAEs，但未延迟手术干预。多变量和敏感性分析证实NICT并非并发症的独立预测因素。本分析提供了以解剖部位为重点的证据，表明在GEJ腺癌的新辅助化疗基础上加用免疫治疗，与主要术后并发症、吻合口失败或手术复杂性风险的统计学显著增加无关。尽管更大规模的随机试验仍是金标准，但这些发现支持将已确立的安全性数据外推至技术要求较高的GEJ部位。
Abstract
Landmark trials have established the surgical feasibility of neoadjuvant immunotherapy plus chemotherapy (NICT) in gastric and esophageal cancers, yet data specific to the narrow anatomical confines of the gastroesophageal junction (GEJ) remain limited. This study aimed to compare postoperative morbidity between patients receiving NICT and those receiving neoadjuvant chemotherapy (NCT) alone. This single-center, retrospective cohort study included consecutive patients with locally advanced GEJ adenocarcinoma (Siewert II/III) undergoing curative resection after NICT (n=140) or neoadjuvant chemotherapy alone (NCT, n=260). Propensity score matching (1:1) balanced baseline characteristics, including dMMR/MSI-H status and surgical approach, yielding 120 matched pairs. The primary outcome was major complications (Clavien-Dindo ≥III). Secondary outcomes included specific surgical complications, immune-related adverse events (irAEs), and interval to surgery. After matching, NICT was associated with improved major pathological regression (58.3% vs. 45.8%; p=0.028). The primary endpoint was not significantly different between NICT and NCT cohorts (25.8% vs. 22.5%; p=0.538). Critically, no differences were observed in specific technical complications, including anastomotic leak (11.7% vs. 10.0%), conduit failure (3.3% vs. 2.5%), or pulmonary events. irAEs occurred in 13.3% of the NICT cohort without delaying surgical intervention. Multivariable and sensitivity analyses confirmed NICT was not an independent predictor of morbidity. This analysis provides anatomically focused evidence that the addition of immunotherapy to neoadjuvant chemotherapy for GEJ adenocarcinoma is not associated with a statistically significant increase in risk of major postoperative morbidity, anastomotic failure, or operative complexity. While larger randomized trials remain the gold standard, these findings support the extrapolation of established safety data to the technically demanding GEJ location.
如何引用
AMA
Huiliang Zhang, Qingwen Huang, Jitao Du, Xiangbin Wan. Does adding immunotherapy to neoadjuvant chemotherapy increase postoperative morbidity in gastroesophageal junction adenocarcinoma? A propensity score-matched study.. Frontiers in immunology. 2026; doi:10.3389/fimmu.2026.1806803.
APA
Huiliang Zhang, Qingwen Huang, Jitao Du, Xiangbin Wan (2026). Does adding immunotherapy to neoadjuvant chemotherapy increase postoperative morbidity in gastroesophageal junction adenocarcinoma? A propensity score-matched study.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1806803
GB/T 7714
Huiliang Zhang, Qingwen Huang, Jitao Du, Xiangbin Wan. Does adding immunotherapy to neoadjuvant chemotherapy increase postoperative morbidity in gastroesophageal junction adenocarcinoma? A propensity score-matched study.[J]. Frontiers in immunology, 2026 doi:10.3389/fimmu.2026.1806803.
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