Title : Comparative efficacy and safety of neoadjuvant immunochemotherapy versus chemotherapy in locally advanced esophageal squamous cell carcinoma
Abstract:
Purpose: Esophageal cancer is characterized by a high global incidence and mortality rate. Current neoadjuvant protocols including neoadjuvant chemotherapy (NCT) demonstrate limited efficacy in controlling recurrence and metastasis for locally advanced esophageal squamous cell carcinoma (LA-ESCC). Neoadjuvant immunochemotherapy (NICT), which integrates immunotherapy with chemotherapy, is gaining attention as a potential approach to enhance treatment outcomes, although its comparative efficacy relative to NCT remains insufficiently investigated. The aim of this study is to assess the efficacy and safety of NICT in comparison to NCT in patients with LA-ESCC.
Methods: This retrospective study encompassed 276 patients diagnosed with LA-ESCC. Participants were allocated into NICT and NCT cohorts. Comparative analyses were conducted on pathological outcomes, including pathological complete response (pCR) and major pathological response (MPR), perioperative complications such as respiratory issues and anastomotic leakage, and survival outcomes, specifically disease-free survival (DFS) and overall survival (OS). Logistic regression and Cox proportional hazards models were employed to identify factors influencing pCR and DFS.
Results: The study demonstrated that NICT was associated with significantly higher rates of pCR at 31.62% compared to 11.95% (p < 0.001), and MPR at 53.85% compared to 32.08% (p < 0.001), relative to NCT. Moreover, DFS was notably improved in the NICT group (p < 0.001). The incidence of respiratory complications was also reduced in the NICT group (p = 0.02).
Conclusions: NICT demonstrated superior efficacy over NCT in enhancing pathological response and survival outcomes, while also minimizing perioperative complications, thereby supporting its application in the treatment of LA-ESCC.
