| Esophageal cancer(EC)is the sixth most common malignancy in the world[1].The epidemiological characteristics of countries vary greatly.Esophageal cancer in China accounts for more than 50%of global morbidity and mortality[2].More than 90%of EC patients in China are esophageal squamous cell carcinoma(ESCC).The typical symptoms of esophageal cancer are progressive difficulty swallowing,first dry food,then semi-liquid food,and finally water and saliva.While esophageal cancer seriously endangers patients'lives,it also seriously damage the quality of life.The patient's body condition(such as gender,age,immune function,cardiopulmonary function),disease characteristics(such as tumor size,pathological type,differentiation degree,TNM stage,growth site.etc.and treatment measures(surgery,radiotherapy and chemotherapy regimen)all have an important impact on the prognosis of patients.Therefore,effective treatment for different conditions is very important.Currently,the treatment methods are surgery,radiotherapy,chemotherapy and combination therapy.With only surgical treatment,the prognosis of local late stage is poor,and the 5-year survival rate is only 25%[3|.Clinicians continue to explore and try to add a variety of radiotherapy and chemotherapy regimens to the surgical treatment regimens in order to improve patients' quality of life and longer survival.With the progress of research,it is found that radiotherapy and chemotherapy play an increasingly important role.Radiotherapy and chemotherapy can not only provide opportunities for surgery,but also make a great contribution to patients' prognosis.Therefore,in recent years,the clinical research of comprehensive treatment has been progressing.A number of randomized controlled studies of preoperative radiotherapy plus surgery and simple surgery have shown that preoperative radiotherapy can only improve the resection rate but not prolong the survival time.Preoperative chemotherapy has not been shown to improve survival.And now with esophageal cancer neoadjuvant chemoradiotherapy(cRT)and surgery treatment mode of special attention,it through the local tumor,surgery and radiation therapy to kill by chemotherapy to kill the distant metastases,preoperative radiotherapy,and chemotherapy can synergy at the same time,improve the local control,prevention of distant metastases.thus improve the survival rate of the treatment of theory is very scientific.Unfortunately,the results of several randomized controlled studies reported in the literature showed that preoperative chemoradiotherapy plus surgery only increased tumor-free survival,but it is beneficial to the survival of patients with complete pathological response,and the risks of surgery are also increasing.Recent studies have shown that preoperative radiotherapy and chemotherapy are beneficial for the survival of esophageal cancer,especially locally advanced esophageal cancer.Therefore,the value of neoadjuvant chemoradiotherapy before esophageal cancer is controversial.Preoperative radiotherapy and chemotherapy is a hot topic,and it is also a very promising treatment model.But its value needs to be further proved.The use of more effective and low-toxic radiochemotherapy regimen to further increase the pCR rate;The future direction is to improve the survival rate and reduce the risk of operation.Recent studies have shown that concurrent neoadjuvant chemoradiotherapy combined with surgery is beneficial to prolong survival[4].However,results were different in randomized controlled trials comparing NCRT combined with surgery with surgery alone[5-13].Whether these results can be applied to East Asian countries with high incidence of ESCC,needs further study.Therefore,further studies are needed to investigate the efficacy of NCRT.All patients in the phase ? trial were locally advanced.We mainly compared the survival benefits of NCERT combined surgery and simple surgery.Patients entered the study after completing the required examination and evaluation according to the criteria of case selection,all patients signed informed consent.The differences in disease-free survival,total survival,safety and quality of life between the experimental group(neoadjuvant chemoradiotherapy combined with surgery)and the control group(surgery alone)were observed.We look forward to finding the best treatment model through this trial.In order to screen out the most suitable patients for neoadjuvant chemoradiotherapy,we studied the predictive value of LncRNA and other markers for pathological reactions of neoadjuvant chemoradiotherapy.Section ? Neoadjuvant chemoradiotherapy combined with surgery versus surgery alone for locally advanced esophageal squamous cell carcinomaBackground:Simple surgical treatment is not effective for ESCC.Clinicians explore new treatment models with a view to improving efficacy.At present,there is no consensus on the efficacy of preoperative radiotherapy and chemotherapy for locally advanced ESCC.In this study,we compared the prognostic and safety differences between NCRT combined surgery and surgery alone in the treatment of locally advanced ESCC patients.Materials:A total of 226 patients with excisable ESCC were enrolled,and were randomly included in the NCRT combined operation group(CRT group,n=112)and the simple operation group(S group,n=114).The primary endpoint was Overall survival(OS),the second endpoint we wanted to compare was disease-free survival(DFS),safety,RO resection,and pathological remission.Results:The pathological complete response rate of CRT group was 40.4%.The median survival rate of CRT group was better than that of s group(100.1 months versus 66.5 months;hazard ratio[HR]0.71;95%CI,0.53-0.96;P=0.025),and longer disease-free survival(100.1 months versus 41.7 months;[HR]0.58,95%CI 0.43-0.78;P<0.001).Leukopenia(48.2%)and granulocytopenia(45.5%)were the most common 3/4 degree chemotherapy adverse events.The rate of arrhythmia was lower in S group(4.5%in S group.11.6%in CRT group and P=0.001),and no significant difference in other postoperative complications.Through analysis,it can be concluded that NCRT combined surgery and low T stage are independent factors for good prognosis.Conclusions:This study shows that for locally advanced ESCC,NCRT combined surgery has a longer survival period than surgical treatment alone,and its adverse events are acceptable and controllable.We believe that this study can provide reference for the treatment of locally advanced ESCC.Section ? Complete pathological remission of esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy:from a prospective randomized phase III trial NEOCRTEC5010Background:Although surgery is the primary choice for the treatment of esophageal cancer,but it didn't work as well.At present,there are no relevant studies to verify the pathological status of esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy.The study was designed to investigate the relationship between pathologic complete response(pCR)and survival after neoadjuvant chemoradiotherapy for locally advanced ESCC.Background data:pCR is of great significance in evaluating and predicting the effects of NCRT on postoperative outcomes,but there are few studies on ESCC alone.Materials:All patients included in NEOCRTEC5010 trial(NCT0116527)who received NCRT before operation.Statistical methods:Kaplan-Meier and log-rank test,Cox regression analysis.Results:of 185 patients,80(43.2%)achieved pCR after NCRT.The average OS of pCR patients was significantly better than that of non-PCR patients(92.6 months vs.69.2 months;HR,2.45;95%CI,1.45-4.11;P=0.00075).In the PCR group,the 5-year OS was 79.3%,and the 5-year DFS was 77%;while those of the non-pcr group were 54.8%and 51.2%.Results:Both OS and DFS of lymph node pCR group benefited significantly.And,we found that N staging,number of lymph nodes dissection,and pathological complete response(pCR or non-pcr)were independent risk factors for DFS and OS.Conclusions:Neoadjuvant chemoradiotherapy can reduce tumor staging and achieve pCR in some patients receiving NCRT.It reduces micrometastases,increases resection rates,and ultimately improves survival.pCR after NCRT is an important prognostic indicator for OS and DFS in ESCC patients.In addition,lymph node status is valuable in predicting the prognosis of esophageal cancer.Traditionally lymph node status is also valuable in pathological staging.In this study,patients with complete lymph node pCR had a better prognosis,while patients with partial lymph node pCR had a poorer prognosis.In the prognostic assessment,lymph node status appears to be a better parameter than pCR.Section ? LncRNA predicts pathological response of ESCC to neoadjuvant chemoradiotherapyBackground:Compared with surgery alone,surgery after NCRT improves the survival rate of ESCC patients.However,the effects of radiotherapy and chemotherapy are heterogeneous,and currently there is no ideal method to predict the pathological response of NCRT.To explore the value of LncRNA markers in the prediction of the efficacy of neoadjuvant chemoradiotherapy(NCRT)in esophageal squamous cell carcinoma(ESCC).Materials:LncRNA expression analysis was performed on 24 ESCC tissue samples that were responsive and non-responders,and real-time quantitative polymerase chain reaction(qPCR)verified the analysis results.We used gene expression data for modeling.We used the PCR data of the second group of 8 ESCC cases to assess the predictive power of the model.Results:We detected 73 differentially expressed LncRNAs between those with pathological reactions and those without reactions,and the changes were more than 2 times,P<0.05.A random forest prediction model consisting of four types of LncRNAs(RP11-1250115.3,IGHV30R16-9,CTA-313A17-3,and NONHSAT006612)was established.We found that the accuracy of identifying pathological responders and non-responders was 0.939 and 0.873,respectively.Conclusions:The combined qPCR of 4 LncRNAs provided the possibility for the prediction of ESCC NCRT reaction and promoted the individualized treatment of ESCC.Sample prospective validation needs to be further expanded to test model effectiveness. |
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