Adding anti-PD-1 antibody to definitive chemoradiotherapy in elderly patients with esophageal squamous cell carcinoma: higher intensity does not equate to better outcomes

医学 内科学 肿瘤科 放化疗 抗体 食管鳞状细胞癌 前瞻性队列研究 强度(物理) 食管癌 鳞状细胞癌 彭布罗利珠单抗 食管 单克隆抗体 抗体疗法 放射科 外科 胃肠病学 细胞 化疗
作者
Peiying Cen,Biqi Chen,Biqi Chen,Wenxi Zhou,Z. Li,Z. Li,Xingyuan Cheng,X. Cheng,Lirong Tian,Guangkuo Wei,Shiliang Liu,Yujin Xu,Yujin Xu,Heng Zhang,M. Xi,Baoqing Chen,Baoqing Chen,Qiaoqiao Li
出处
期刊:Annals of Medicine [Informa]
卷期号:58 (1): 2622762-2622762 被引量:1
标识
DOI:10.1080/07853890.2026.2622762
摘要

Background and purpose The benefit of adding anti-PD-1 antibodies to definitive chemoradiotherapy (dCRT) in elderly patients with esophageal squamous cell carcinoma (ESCC) remains uncertain. This study evaluated its efficacy and safety versus dCRT alone.Materials and methods We retrospectively analyzed the patients aged ≥ 70 years with ESCC treated at three academic centers from 2009 to 2023. All patients received first-line dCRT and the study group additionally received anti-PD-1 antibodies (IO group). Propensity score matching (PSM) was applied to balance baseline factors.Results A total of 241 patients were enrolled, including 130 in the IO group and 111 in the dCRT group. After 1:1 PSM (110 patients per group), no significant differences in overall survival (OS) or progression-free survival (PFS) were observed. The median OS was 34.5 vs 33.7 months (HR = 0.86, 95%CI: 0.58–1.28, p = 0.467) and median PFS was 29.8 vs 17.8 months (HR = 0.79, 95%CI: 0.55–1.13, p = 0.194). Multivariate Cox analysis identified high nutritional risk as an independent predictor of worse OS (p = 0.014), while both advanced TNM stage (p = 0.030) and high nutritional risk (p = 0.016) were independently associated with shorter PFS. Subgroup analyses suggested that patients with good performance, better nutritional status or lower comorbidity burden may benefit from combination therapy. Grade 3–4 adverse events were comparable between two groups.Conclusion Adding anti-PD-1 antibodies to dCRT did not result in a significant improvement in OS or PFS in the ESCC patients aged ≥ 70 years; however exploratory findings indicate a potential PFS signal in selected patients with favorable baseline conditions, which requires confirmation in prospective studies.
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