The improvement efficacy of consolidation chemotherapy after definitive concurrent chemotherapy and radio-therapy (CCRT) on the prognosis of patients with locally advanced esophageal squamous cell carcinoma (ESCC) remains controversial. In addition, there is a lack of nutritional risk screening tools which can consistently and accurately predict the survival of patients with esophageal cancer.

To investigate the effect of consolidation chemotherapy on the prognosis of patients with locally advanced ESCC receiving definitive CCRT.

A total of 223 patients with ESCC who received definitive CCRT in the department of radiotherapy, the Fourth Hospital of Hebei Medical University from January 2013 to December 2018 were selected as the research objects and divided into the simple CCRT group (n=87) and combined consolidation chemotherapy group (n=136) according to chemoradiotherapy regimen adopted by the patients. General data, ECOG score, tumor site, tumor length, TNM stage, radiotherapy dose, irradiation mode and chemotherapy regimen of the included patients were collected by electronic medical record system. Nutritional Risk Screening 2002 (NRS 2002) was used to score the nutritional status of the patients before chemoradiotherapy. Efficacy evaluation was performed within 1 month after CCRT, including complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Patients were followed up by telephone (completed by the follow-up center) and outpatient review until 2022-09-30, with overall survival (OS), local relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) collected. Survival curves of OS, LRRFS and DMFS were plotted by Kaplan-Meier method and compared by Log-rank test. Univariate and multivariate Cox risk regression models were used to explore the influencing factors of patient prognosis.

There was no significant difference in baseline data between the simple CCRT group and combined consolidation chemotherapy group (P>0.05). There was no significant difference in the rates of OS, LRRFS and DMFS between the two groups (χ²=1.942, 0.743, 1.272; P=0.163, 0.389, 0.259). There were significant differences in the rates of OS, LRRFS and DMFS between patients with NRS 2002 score <3 (n=172) and patients with NRS 2002 score≥3 (n=51) before treatment (χ²=6.585, 4.858, 7.814; P=0.010, 0.028, 0.005). Multivariate Cox proportional hazard regression analysis showed that TNM stage and NRS 2002 score were influencing factors of OS and DMFS (P<0.05), irradiation mode was an influencing factor of LRRFS and DMFS (P<0.05), and clinical efficacy was an influencing factors of OS, LRRFS and DMFS (P<0.05). Stratified analysis showed that in patients with TNM stage Ⅱ and clinical efficacy of CR, the OS rates in the combined consolidation chemotherapy group (n=74, n=33) were significantly higher than those in the simple CCRT group (n=43, n=28), with statistically significant differences (χ²=4.811, 3.932; P=0.028, 0.047) .

Consolidation chemotherapy did not improve the prognosis of stageⅡ-Ⅲ ESCC patients after definitive CCRT, but may bring survival benefits for patients with early clinical stage, good response and nutritional status. As a nutritional risk screening tool, NRS 2002 has significant predictive value for the long-term survival of patients with locally advanced ESCC after chemoradiotherapy.

根治性同步放化疗后行巩固化疗能否改善局部晚期食管癌患者预后存在较大争议。临床中缺乏能够稳定、准确判断食管癌患者生存的营养风险筛查工具。

探讨巩固化疗对接受根治性同步放化疗的局部晚期食管鳞状细胞癌患者预后的影响。

选取2013年1月—2018年12月于河北医科大学第四医院放疗科行根治性同步放化疗的食管鳞状细胞癌患者223例为研究对象，依据患者采用的放化疗方案，将患者分为单纯同步放化疗组（87例）和联合巩固化疗组（136例）。通过电子病历系统收集患者一般资料、美国东部肿瘤协作组（ECOG）评分、肿瘤部位、肿瘤长度、TNM分期、放疗剂量、照射方式、化疗方案等。应用营养风险筛查2002（NRS 2002）对患者放化疗前营养状况进行评分。患者同步放化疗结束1个月内进行疗效评价，包括完全缓解（CR）、部分缓解（PR）、疾病稳定（SD）及疾病进展（PD）。患者通过电话（本院随访中心完成）及门诊复查进行随访，收集患者的总生存期（OS）、无局部区域复发生存期（LRRFS）及无远转生存期（DMFS）情况，随访截至2022-09-30。采用Kaplan-Meier法绘制患者OS、LRRFS、DMFS的生存曲线，生存曲线的比较采用Log-rank检验。采用单因素及多因素Cox比例风险回归分析探讨患者预后的影响因素。

单纯同步放化疗组和联合巩固化疗组患者基线资料比较，差异无统计学意义（P>0.05）。两组总生存率、无局部区域复发生存率、无远转生存率比较，差异均无统计学意义（χ²=1.942、0.743、1.272，P=0.163、0.389、0.259）。治疗前NRS 2002评分<3分患者172例，NRS 2002评分≥3分患者51例，两组总生存率、无局部区域复发生存率、无远转生存率比较，差异有统计学意义（χ²=6.585、4.858、7.814，P=0.010、0.028、0.005）。多因素Cox比例风险回归分析结果显示，TNM分期、NRS 2002评分为患者OS、DMFS的影响因素（P<0.05），照射方式为患者LRRFS、DMFS的影响因素（P<0.05），临床疗效为患者OS、LRRFS、DMFS的影响因素（P<0.05）。分层分析结果显示，在TNM分期Ⅱ期及临床疗效CR的患者中，联合巩固化疗组（74例、33例）总生存率高于单纯同步放化疗组（43例、28例）（χ²=4.811、3.932，P=0.028、0.047）。

巩固化疗并未改善临床Ⅱ~Ⅲ期食管鳞状细胞癌患者根治性同步放化疗后的预后生存，但对于临床分期偏早、病变缓解良好、营养状况良好的患者，巩固化疗可能带来一定的生存获益。NRS 2002作为营养风险筛查工具对局部晚期食管癌患者放化疗后的长期生存有显著的预测价值。