Table 1_Prognostic factors in locally advanced oesophageal squamous cell carcinoma: a clinical and radiomic analysis of neoadjuvant immunochemotherapy before surgery.docx

BackgroundThe treatment of locally advanced oesophageal squamous cell carcinoma (LAESCC) without distant metastasis remains a subject of debate. Neoadjuvant immunochemotherapy (NIC) combined with surgery is the preferred initial approach for managing LAESCC. However, information on the clinical efficacy and survival of patients with LAESCC treated with NIC followed by surgery is limited.
MethodsThis retrospective analysis aimed to identify predictors NIC treatment effectiveness and on patient survival. We developed a Cox proportional hazards model and Kaplan–Meier curve to estimate progression-free survival (PFS) and overall survival (OS) following NIC treatment and surgery.
ResultsOverall, 225 patients with LAESCC were divided into training (157) and test set (68) (7:3). After a median follow-up of 2.86 years, death was observed as a positive event in 41 patients (26.1%). It is statistically significant to construct a prediction model combining radiomics features pre- and post-NIC with clinical features to predict the PFS and OS of LAESCC. The combined model showed the highest performance in predicting both disease-free survival and OS compared with the clinical or radiomics models. multivariate Cox regression analysis identified smoking (HR = 1.417, 95% confidence interval [CI]: 0.875–2.293, p = 0.156), Ki67(HR = 2.426, 95% confidence interval [CI]: 1.506–3.908, p = 0.000) and postRad-S1 (HR = 1.867, 95% CI: 1.053–3.311, p = 0.033) as significant independent covariates associated with high PFS. While Ki67 and postRad-S2 were prognostic factors significantly associated with OS (HR = 1.521, 95% CI: 0.821–2.818, p = 0.183; HR = 1.912, 95% CI: 1.001–3.654, p = 0.050, respectively).
ConclusionFor patients with LAESCC treated with NIC followed by surgery, the combined model effectively evaluated the efficacy of NIC and predicted PFS and OS. Additionally, different independent predictors were associated with PFS and OS, providing clues for future studies.

背景 无远处转移的局部晚期食管鳞状细胞癌（locally advanced oesophageal squamous cell carcinoma，LAESCC）的治疗方案仍存在争议。新辅助免疫化疗（Neoadjuvant immunochemotherapy，NIC）联合手术是目前LAESCC临床管理的首选初始方案，但针对接受NIC序贯手术治疗的LAESCC患者，其临床疗效与生存预后相关的研究数据仍较为匮乏。
方法 本回顾性分析旨在探寻可预测NIC治疗疗效及患者生存预后的指标。我们构建了Cox比例风险模型与Kaplan-Meier曲线，以评估NIC联合手术治疗后患者的无进展生存期（progression-free survival，PFS）与总生存期（overall survival，OS）。
结果 本研究共纳入225例LAESCC患者，按7:3的比例分为训练集（157例）与测试集（68例）。中位随访时长为2.86年，其中41例患者（占比26.1%）发生死亡终点事件。将NIC治疗前后的放射组学特征与临床特征相结合构建预测模型，用于预测LAESCC患者的PFS与OS，该模型具有统计学意义。相较于单纯临床特征模型或单纯放射组学特征模型，联合模型对无病生存期与OS的预测效能均最优。多因素Cox回归分析显示，吸烟（风险比HR=1.417，95%置信区间CI：0.875~2.293，p=0.156）、Ki67（HR=2.426，95%CI：1.506~3.908，p<0.001）与postRad-S1（HR=1.867，95%CI：1.053~3.311，p=0.033）为与高PFS显著相关的独立危险因素。而Ki67与postRad-S2则为与OS显著相关的预后因素（分别为HR=1.521，95%CI：0.821~2.818，p=0.183；HR=1.912，95%CI：1.001~3.654，p=0.050）。
结论 对于接受NIC序贯手术治疗的LAESCC患者，联合模型可有效评估NIC的治疗疗效并预测其PFS与OS。此外，与PFS和OS相关的独立预测因子存在差异，该结果可为未来相关研究提供参考方向。