Comparison of pathologic response and survival outcomes between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant immunochemotherapy (nICT) in patients with locally advanced esophageal squamous cell carcinoma: a propensity score-matched analysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967800 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2407 (Electronic) Linking ISSN: 14712407 NLM ISO Abbreviation: BMC Cancer Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Neoadjuvant Therapy*/methods ; Esophageal Squamous Cell Carcinoma*/therapy ; Esophageal Squamous Cell Carcinoma*/mortality ; Esophageal Squamous Cell Carcinoma*/pathology ; Propensity Score* ; Esophageal Neoplasms*/therapy ; Esophageal Neoplasms*/mortality ; Esophageal Neoplasms*/pathology; Humans ; Male ; Female ; Middle Aged ; Aged ; Chemoradiotherapy/methods ; Retrospective Studies ; Immunotherapy/methods ; Treatment Outcome ; Esophagectomy ; Adult ; Survival Rate ; Neoplasm Staging

Background: In locally advanced, operable esophageal squamous cell carcinoma (ESCC), neoadjuvant immunochemotherapy (nICT) has shown results that are somewhat comparable to those of standard neoadjuvant chemoradiotherapy (nCRT). The impact of these neoadjuvant treatments on survival outcomes, however, has yet to be elucidated.
Methods: This study included 489 patients with locally advanced ESCC who underwent surgery at Sichuan Cancer Hospital after receiving neoadjuvant treatment between June 2017 and September 2023. Patients were categorized into nCRT and nICT groups based on whether they received neoadjuvant treatment. To mitigate potential biases and balance covariates between the two cohorts, 1:2 propensity score matching (PSM) was conducted using a caliper width of 0.05.
Results: After PSM, the baseline characteristics of the 360 patients remained balanced between the two groups. The findings indicated a superior pathological response in the nCRT group, as evidenced by significantly greater rates of complete response (32.87% vs 14.58%, P < 0.001) and favorable tumor regression grade (TRG), as well as reduced ypT stages and less perineural and angioinvasion, despite comparable ypN stages. Despite the improvement in complete pathological response (pCR) in the nCRT group, the 3-year disease-free survival (DFS) and overall survival (OS) rates did not significantly differ between the groups (DFS: 58.32% vs 56.16%, P = 0.67; OS: 69.96% vs 71.99%, P = 0.99). Crucially, The nICT group showed a lower incidence of grade 3 and 4 adverse events in Leukopenia (2.8% vs 29%; P < 0.001) and Neutropenia (2.8% vs 24%; P < 0.001) during neoadjuvant treatment, comparing with nCRT group.
Conclusions: Our preliminary findings suggest that nICT followed by surgery offers comparable survival rates to nCRT, despite being less effective in pathologic outcomes. Nonetheless, nICT is a safe and feasible strategy for locally advanced ESCC, warranting further exploration to understand its impact on long-term survival.
(© 2024. The Author(s).)

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2023YFS0488 Science and Technology Department of Sichuan Province

Keywords: Locally advanced esophageal squamous cell carcinoma; Neoadjuvant chemoradiotherapy; Neoadjuvant immunochemotherapy; Pathologic response; Propensity Score Matching (PSM)

Date Created: 20241005 Date Completed: 20241005 Latest Revision: 20241008

20241008

PMC11453051

10.1186/s12885-024-12946-8

39369225