ObjectiveTo investigate the impact of clinicopathological factors on the prognosis of patients with single-organ oligometastasis of esophageal cancer (soOMEC) following surgery and to develop prognostic nomograms.MethodsThis was a retrospective analysis of 144 patients with soOMEC after surgery in a single center who met the inclusion criteria. First, Cox univariate and multivariate models were used to analyze (SPSS 25.0 statistical software) the characteristics of patients, and independent prognostic factors for postoperative overall survival (OS) and OS after oligometastasis (OM-OS) were determined. Prognosis was analyzed using R language software, nomograms were created based on the Cox multivariate analysis results, a bootstrap method (b=200) was used for internal validation, and receiver operating characteristic (ROC) and calibration curves were used to validate the models.ResultsFrom January 2014 to December 2017, a total of 1595 patients with esophageal cancer received R0 resection. As of the end of the follow-up period, 144 patients had single-organ oligometastasis (soOM). The median time to oligometastasis (TTO) in the whole group of patients was 14.2 months, and the 1-, 3-, and 5-year OS rates were 75.7%, 28.2%, and 13.3%, respectively. The median OS was 25.0 months (95% confidence interval (CI): 21.8-28.2); the 1-, 2-, and 3-year OS rates after distant metastasis (DM-OS) were 25.5%, 13.3%, and 7.2%, respectively, and the median DM-OS was 5.5 months (95% CI: 3.9-7.1). The Cox multivariate analysis results showed that three indicators, i.e., TNM stage (hazard ratio (HR)=2.192, 95% CI: 1.441-3.336, P=0.000), TTO (HR=0.119, 95% CI: 0.073-0.194, P=0.000), and treatment after DM (HR=0.784, 95% CI: 0.970-0.025, P=0.025) were independent prognostic factors affecting the OS of patients; TTO (HR=0.669, 95% CI: 0.455-0.984, P=0.041) and treatment after DM (HR=0.713, 95% CI: 0.559-0.910, P=0.007) were independent prognostic factors affecting the DM-OS of patients. Using the Cox multivariate analysis results, prediction nomograms for total OS and DM-OS of patients were established. In the validation of the nomogram models, the areas under the curve (AUCs) for the 1-, 3-, and 5-year total OS were 0.930, 0.927, and 0.928 in the training set and 0.705, 0.856, and 1 in the validation set, respectively; the AUCs for the 1-, 2-, and 3-year DM-OS were 0.904, 0.923, and 0.908 in the training set and 0.928, 0.842, and 0.895 in the validation set, respectively. The results showed that the two models have strong discriminative ability and good clinical promotion and application value.ConclusionsAggressive local therapy combined with systemic chemotherapy can benefit patients with soOMEC after surgery, and for patients with OM appearing at 1 year after surgery, aggressive radiotherapy or combined chemotherapy is expected to improve the prognosis and prolong OS. The nomogram models developed in this study demonstrated strong predictive performance in internal validation and hold potential as clinical tools for estimating the prognosis of patients and assisting in treatment decision-making. However, their true clinical utility and generalizability require further validation through larger, multicenter, and prospective studies.

Objective:To evaluate the efficacy and prognostic factors of radiotherapy combined with immunotherapy as the first-line treatment for patients with locally advanced or metastatic esophageal squamous cell carcinoma (LA/M ESCC).Methods:A single-center, retrospective analysis was conducted for the recent efficacy, survival, prognostic factors, post-treatment failure modes, and treatment-related adverse reactions of 57 LA/M ESCC patients eligible for enrollment.Results:The entire group of patients had 1-, 2-, and 3-year overall survival (OS) of 86.0%, 57.5%, and 53.9%, respectively and 1-, 2-, and 3-year progression-free survival (PFS) of 61.4%, 31.0%, and 31.0%, respectively. The median OS was not reached, and the median PFS was 15.0 (95% CI: 10.77-19.23) months. These patients had an overall response rate (ORR) of 80.7% (46/57) and a disease control rate (DCR) of 94.7% (54/57). As indicated by the result of the multivariate analysis, the independent prognostic factors affecting the OS of the patients included their age, clinical stage, number of immunotherapy cycles, and recent efficacy ( HR = 0.25, 2.58, 0.35, 4.05, P < 0.05), and the independent factors influencing the PFS of the patients included their clinical stage and recent efficacy ( HR = 2.27, 1.97, P < 0.05). There were no statistically significant differences in the effects of irradiation ranges and the combination modes of immunologic drugs and chemoradiotherapy on both OS and PFS of the patients ( P > 0.05). A total of 32 patients suffered post-treatment failure. After the second treatment, they had 1- and 2-year OS of 55.7% and 25.3%, respectively, with median OS of 14.0 (95% CI: 5.17-22.83) months. A total of 26 cases experienced treatment-associated adverse reactions of grades 2 or higher during and after treatment. Conclusions:The combination of radiotherapy and immunotherapy is effective and safe as the first-line treatment for LA/M ESCC patients. The post-treatment failure modes still include local recurrence and distant metastasis. Therefore, such combination merits further investigation.

Objective:To investigate the influence of the depth of invasion on the prognosis of pT1 stage mid-thoracic esophageal cancer patients undergoing left thoracotomy.Methods:Retrospectively analyze the clinicopathological data of 139 patients with pT1N0M0 stage of mid-thoracic esophageal cancer who meet the enrollment criteria. Firstly, the prognosis and influencing factors of the whole group were analyzed. The differences in prognosis, local recurrence and distant metastasis between PT1A and PT1B patients were compared, and the influence of different infiltration depth on prognosis and treatment failure of patients was analyzed. SPSS 19.0 statistical software was used for statistical analysis.Results:The 1-year, 3-year and 5-year overall survival(OS) and disease-free survival(DFS) were 95.0%, 87.8%, 82.0% and 91.4%, 84.2%, 77.0%, respectively. There were significant differences in OS( χ2=7.500, P=0.006) and DFS( χ2=7.354, P=0.007) at 1, 3 and 5 years between pT1a and pT1b patients. Cox multivariate analysis showed that pT stage and pathological type were independent prognostic factors for OS and DFS( P<0.05). There were no significant differences in OS( χ2=0.734, P=0.693) and DFS( χ2=0.7690, P=0.681) of pT1a tumors with different invasion depths. There were significant differences in OS( χ2=15.368, P<0.001) and DFS( χ2=27.470, P<0.001) at 1, 3 and 5 years of pT1b tumors with different invasion depths. The recurrence rate of pT1b(23.8%) was significantly higher than that of pT1a(5.3%)( χ2=5.274, P=0.022). The distant metastasis rate of the former(10.9%) was also significantly higher than that of the latter(0)( χ2=4.494, P=0.034). There were significant differences in local recurrence rate( χ2=17.051, P<0.001) and distant metastasis rate( χ2=15.460, P<0.001) among pT1b patients with different infiltration depths. Logistic multivariate analysis showed that the depth of infiltration was an independent factor affecting the occurrence of local recurrence in stage pT1b patients after treatment( P<0.001). Pathological type( P=0.003) and infiltration depth( P=0.027) were independent factors affecting the occurrence of distant metastasis. Conclusion:pT1a period and pT1b period after the prognosis and treatment of patients with different failure modes, and pT1b period in patients with different infiltration depth and the prognosis of patients and its failure mode after treatment significantly related, infiltration depth of pT1b period after treatment in patients with the independence of the influencing factors of failure, suggest that clinical doctors should pay attention to pT1b period in patients with postoperative adjuvant therapy. This conclusion needs to be confirmed by large prospective studies of cases.

Objective:To investigate the efficacy of camrelizumab combined with second-line therapy in patients with recurrent or metastatic esophageal squamous cell carcinoma (ESCC) in the real-world settings.Methods:Clinical data of 48 patients with esophageal cancer who met the inclusion criteria were retrospectively analyzed. The types of failure after first-line treatment, clinical efficacy, side effects and prognostic factors of second-line treatment were analyzed. SPSS 25.0 software was used for statistical analysis. Count data were expressed by composition ratio and analyzed by Chi-square test or Fisher's exact test. Survival analysis was conducted by Kaplan-Meier curve and log-rank test. Non-normally distributed data were recorded with the median, range and quartile. Results:There were 26, 14, and 4 cases of combined chemoradiotherapy, chemotherapy and radiotherapy in the treatment of second-line camrelizumab, and 4 cases received immunotherapy alone. The median duration of immunotherapy was 6 cycles (range, 2-39 cycles). After second-line treatment, the short-term efficacy of 17, 27 and 4 cases was partial remission (PR), stable disease (SD) and progressive disease (PD), respectively. The overall response rate (ORR) was 35.4% and disease control rate (DCR) was 91.7%. The 1- and 2-year OS rates were 42.9% and 22.5%, and 1- and 2-year PFS rates were 29.0% and 5.8%. The median OS and PFS were 9.0 months (95% CI=6.4-11.7) and 8.5 months (95% CI=1.5-5.6), respectively. Multivariate analysis showed that combined immunotherapy mode, number of cycles of immunotherapy and short-term efficacy were the independent prognostic indicators affecting OS in this group of patients ( HR=2.598, 0.222, 8.330, P=0.044, <0.001, <0.001). Lymphocyte count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), combined immunotherapy mode and short-term efficacy were the independent prognostic indicators affecting PFS in this group ( HR=3.704, 3.598, 6.855, 2.159, 2.747, P=0.009, 0.008, <0.001, 0.049, 0.012). Conclusions:Camrelizumab combined with second-line therapy can bring survival benefit to patients with recurrent or metastatic ESCC after first-line therapy, especially immunotherapy combined with chemoradiotherapy can significantly provide survival benefit. Peripheral blood inflammatory biomarkers are independent indicators affecting clinical prognosis of patients. Patients with better short-term efficacy also achieve better prognosis. The final conclusion remains to be validated by a large number of randomized controlled studies.

Abstract Objective This study was designed to investigate the efficacy and prognostic factors for immune checkpoint inhibitors (ICIs) combined with or without radio(chemo)therapy and to evaluate their toxicity in patients with locally advanced or recurrent/metastatic esophageal squamous cell carcinoma (LA/RM ESCC). Methods In this study, 198 patients with locally advanced or recurrent/metastatic (LA/RM) ESCC who received ICIs combined with or without radiotherapy/chemotherapy in the Department of Radiotherapy of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the prognostic factors for overall survival (OS) and progression free survival (PFS). The factors affecting treatment response and the occurrences of treatment-related adverse events (trAEs) were analyzed. Results The median OS and PFS were 30.4 months (95% confidence interval [CI] 15.1–45.7 months) and 15.3 months (95% CI 12.8–17.8 months), respectively. Univariate and multivariate analysis showed that the number of ICI cycles, the intervention of radiotherapy and dysphagia were independent factors affecting OS (Hazard ratio [HR] = 0.39, 2.043 and 0.365, respectively; P = 0.018, 0.001 and 0.032, respectively). The intervention of radiotherapy was an independent factor for PFS (hazard ratio [HR] = 18.149, P = 0.013). The median OS and PFS for patients who had complete response and partial response (Objective response, ORR) were 50.8 months (95% CI 25.8–75.7 months) and 20.5 months (95% CI 14.1–27.0), respectively, which were significantly higher than those in the non-ORR group (OSnon-ORR:17.5 months, 95% CI 14.0–21.0; χ2 = 13.881, P < 0.001; PFSnon-ORR: 12.1 months, 95% CI 10.1–14.1, χ2 = 10.676, P = 0.001). The intervention of radiotherapy could improve treatment response (χ2 = 47.725, P = 0.000). In entire study population, 83 patients (41.9%) had ≥ grade 2 trAEs. Conclusions ICIs combined with radiotherapy/chemotherapy are safe and effective in LA/RM ESCC patients. Intervention of radiotherapy, the number of immunotherapy cycles and occurrence of dysphagia affecting the overall survival of LR/RM ESCC patients. Intervention of radiotherapy was an independent prognosis factor for OS and PFS and associated with better treatment response.

Abstract Objective: This study was designed to investigate the prognostic factors for immune checkpoint inhibitors (ICIs) combined utilization with radiotherapy (RT)/chemoradiotherapy (CRT) and to evaluate their toxicity in locally advanced or recurrent/metastatic esophageal squamous cell carcinoma (LA/RM ESCC). Methods: In this study, 198 LA/RM ESCC patients who received ICIs combined with RT/CRT in the Department of Radiotherapy of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the prognostic factors for overall survival (OS) and progression-free survival (PFS). Subgroup analysis was utilized to explore the prognostic factors, the treatment respond and treatment-related adverse events (trAEs) were analyzed. Results: The median OS and PFS were 30.4 months (95% confidence interval [CI]: 15.1–45.7 months) and 15.3 months (95% CI: 12.8–17.8 months), respectively. The median OS and PFS for patients achieving objective respond (ORR group, including complete response and partial response) were 50.8 months (95% CI: 25.8–75.7 months) and 20.5 months (95% CI: 14.1–27.0), respectively, which were higher than those in non-ORR group (OSnon-ORR:17.5 months, 95% CI: 14.0–21.0; χ2 = 13.881, P < 0.001; PFSnon-ORR: 12.1 months, 95% CI: 10.1–14.1, χ2 = 10.676, P = 0.001). Results from subgroup analysis illustrated combined ICIs with radiotherapy could improve the treatment respond (χ2 = 47.725, P = 0.000). The OS rate (χ2 = 18.836, P < 0.001) and PFS rate (χ2 = 6.881, P = 0.009) were significantly higher in the whole-lesion radiotherapy group than in the partial-lesion radiotherapy group. Multivariate analysis showed that the number of immune cycles, the coverage of radiotherapy target, the modality of ICIs-combination therapy and treatment response were independent prognosis factors for OS (hazard ratio [HR] = 0.512, 2.043, 1.889, and 1.912, respectively; P = 0.001, 0.001, 0.013, and 0.002, respectively). Radiotherapy coverage and treatment response were independent factors for PFS (HR = 1.478 and 1.597, respectively; P = 0.032 and 0.012, respectively). In the entire study population, 83 patients (41.9%) had ≥ grade 2 trAEs. Conclusions: ICIs combined with radiotherapy/chemoradiotherapy are safe and effective in LA/RM ESCC patients. The addition of radiotherapy could improve the treatment respond and whole-lesion radiotherapy improve prognosis compared with partial-lesion radiotherapy group. The number of immunotherapy cycles and treatment response are the main factors affecting prognosis.