Hongda Lu

Importance: Standard first-line therapy for advanced or metastatic esophageal carcinoma is chemotherapy, but the prognosis remains poor. Camrelizumab (an anti-programmed death receptor 1 [PD-1] antibody) showed antitumor activity in previously treated advanced or metastatic esophageal squamous cell carcinoma. Objective: To evaluate the efficacy and adverse events of camrelizumab plus chemotherapy vs placebo plus chemotherapy as a first-line treatment in advanced or metastatic esophageal squamous cell carcinoma. Design, Setting, and Participants: This randomized, double-blind, placebo-controlled, multicenter, phase 3 trial (ESCORT-1st study) enrolled patients from 60 hospitals in China between December 3, 2018, and May 12, 2020 (final follow-up, October 30, 2020). A total of 751 patients were screened and 596 eligible patients with untreated advanced or metastatic esophageal squamous cell carcinoma were randomized. Interventions: Patients were randomized 1:1 to receive either camrelizumab 200 mg (n = 298) or placebo (n = 298), combined with up to 6 cycles of paclitaxel (175 mg/m2) and cisplatin (75 mg/m2). All treatments were given intravenously every 3 weeks. Main Outcomes and Measures: Coprimary end points were overall survival (significance threshold, 1-sided P < .02) and progression-free survival (significance threshold, 1-sided P < .005). Results: Of the 596 patients randomized (median age, 62 years [interquartile range, 56-67 years]; 523 men [87.8%]), 1 patient in the placebo-chemotherapy group did not receive planned treatment. A total of 490 patients (82.2%) had discontinued the study treatment. The median follow-up was 10.8 months. The overall survival for the camrelizumab-chemotherapy group was a median of 15.3 months (95% CI, 12.8-17.3; 135 deaths) vs a median of 12.0 months (95% CI, 11.0-13.3; 174 deaths) for the placebo-chemotherapy group (hazard ratio [HR] for death, 0.70 [95% CI, 0.56-0.88]; 1-sided P = .001). Progression-free survival for camrelizumab plus chemotherapy was a median of 6.9 months (95% CI, 5.8-7.4; 199 progression or deaths) vs 5.6 months (95% CI, 5.5-5.7; 229 progression or deaths) for the placebo-chemotherapy group (HR for progression or death, 0.56 [95% CI, 0.46-0.68]; 1-sided P < .001). Treatment-related adverse events of grade 3 or higher occurred in 189 patients (63.4%) in the camrelizumab-chemotherapy group and 201 (67.7%) in the placebo-chemotherapy group, including treatment-related deaths among 9 patients (3.0%) and 11 patients (3.7%), respectively. Conclusions and Relevance: Among patients with advanced or metastatic esophageal squamous cell carcinoma, the addition of camrelizumab to chemotherapy, compared with placebo and chemotherapy, significantly improved overall survival and progression-free survival. Trial Registration: ClinicalTrials.gov Identifier: NCT03691090.

Objectives: To evaluate the short-term outcomes of uniportal video-assisted thoracoscopic surgery (UVATS) and Da Vinci robot-assisted thoracoscopic surgery (RATS) in lobectomy and lymph node (LN) dissection. Methods: The two groups of patients with primary non-small cell lung cancer (NSCLC; RATS group, UVATS group) were matched by the propensity score to compare LN dissection and recent clinical outcomes. The results were analyzed by univariate analysis. From November 2020 to November 2021, 412 NSCLC patients (54 RATS and 358 UVATS) from a single institution of the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. Age, sex, lung lobe, surgical resection scope, solid nodules, and core tumor ratios were matched according to different surgical methods. Results: From November 2020 to November 2021, 412 patients with NSCLC (54 RATS, 358 UVATS) from the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. According to our matching results, LN dissection was more thorough in the RATS group. Conclusion: RATS has potential advantages over UVATS in radical lung cancer surgery.

Purpose: To evaluate the prognostic value of the monocyte to lymphocyte ratio (MLR) and folate receptor-positive circulating tumor cells (FR+CTCs) in patients with colorectal cancer (CRC) and to develop predictive model for post-treatment survival using machine learning (ML) algorithms. Methods: We retrospectively analyzed 67 CRC patients treated with radical surgery or chemoradiotherapy at The Central Hospital of Wuhan from January 2020 to December 2022. MLR, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and FR+CTCs were categorized into high and low groups and clinicopathologic features were compared. Progression-Free Survival (PFS) and Overall Survival (OS) were analyzed using COX analysis and the Kaplan-Meier survival curve. Three ML algorithms, namely, random forest (RF), support vector machine (SVM), and logistic regression (LR), were utilized to construct the predictive models, and their performance metrics including accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), precision, recall, F1 value, AUC, and calibration curve were compared. Results: MLR, FR+ CTCs, and T stage independently predicted PFS (P<0.05), both higher MLR and FR+CTCs levels indicating a significantly shorter PFS (P=0.004). The T stage was the only factor predictive of OS (P=0.043). NLR and PLR did not show significant prognostic effects on PFS or OS (P > 0.05). The RF model demonstrated superior performance with an accuracy of 0.63, sensitivity of 0.69, PPV of 0.75, a precision of 0.43, a recall of 0.5, and an F1 value of 0.43, outperforming the other models. Conclusion: High MLR and high FR+CTCs are associated with a poorer PFS in CRC patients, suggesting their utility in prognostic assessment. NLR and PLR did not show significant prognostic value in this study. The RF algorithm-based model showed the best predictive performance for post-radical treatment outcomes in CRC.