The addition of pembrolizumab to neoadjuvant chemoradiotherapy did not increase the risk of developing postoperative anastomotic leakage for ESCC: an analysis from a prospective cohort

• Published in: BMC cancer Vol. 24; no. 1; pp. 1029 - 10
• Main Authors: Qi, Wei-Xiang, Li, Shuyan, Li, Huan, Chen, Jiayi, Zhao, Shengguang
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.08.2024; BioMed Central; BMC
• Subjects: Adult; Aged; Anastomosis; Anastomotic leak; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; Anastomotic leakage; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Antineoplastic Agents, Immunological - administration & dosage; Antineoplastic Agents, Immunological - adverse effects; Antineoplastic Agents, Immunological - therapeutic use; Cancer therapies; Care and treatment; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Complications; Complications and side effects; Computed tomography; CT imaging; Dosimetry; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophageal squamous cell carcinoma; Esophageal Squamous Cell Carcinoma - pathology; Esophageal Squamous Cell Carcinoma - therapy; Female; Gastric fundus; Humans; Lymphatic system; Male; Medical colleges; Medical research; Medicine, Experimental; Methods; Middle Aged; Mortality; Neoadjuvant chemoradiotherapy; Neoadjuvant therapy; Neoadjuvant Therapy - adverse effects; Neoadjuvant Therapy - methods; Nomogram; Nomograms; Patients; Pembrolizumab; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prediction models; Prospective Studies; Radiation therapy; Regression analysis; Retrospective Studies; Risk Factors; Squamous cell carcinoma; Surgery; Surgical anastomosis; Tomography; China; Gastric fundus; Esophageal squamous cell carcinoma; Pembrolizumab; Anastomotic leakage; Nomogram; Neoadjuvant chemoradiotherapy
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-024-12774-w

To compare the difference of postoperative anastomotic leakage (AL) rate between neoadjuvant chemoradiotherapy (NCRT) with pembrolizumab and NCRT group, and investigate the risk factors of developing AL for locally advanced esophageal squamous cell cancer (ESCC). The GF was contoured on the pretreatment planning computed tomography and dosimetric parameters were retrospectively calculated. Univariate and multivariate logistic regression analysis was performed to determine the independent risk predictors for the entire cohort. A nomogram risk prediction model for postoperative AL was established. A total of 160 ESCC patients were included for analysis. Of them, 112 were treated with NCRT with pembrolizumab and 44 patients with NCRT. Seventeen (10.6%) patients experienced postoperative AL with a rate of 10.7% (12/112) in NCRT with pembrolizumab and 11.4% (5/44) in NCRT group. For the entire cohort, mean, D50, Dmax, V5, V10 and V20 GF dose were statistically higher in those with AL (all p < 0.05). Multivariate logistic regression analysis indicated that tumor length (p = 0.012), volume of GF (p = 0.003) and mean dose of GF (p = 0.007) were independently predictors for postoperative AL. Using receiver operating characteristics analysis, the mean dose limit on the GF was defined as 14 Gy. Based on our prospective database, no significant difference of developing AL were observed between NCRT with pembrolizumab and NCRT group. We established an individualized nomograms based on mean GF dose combined with clinical indicators to predict AL in the early postoperative period.