ArticleTechnology in cancer research & treatment
Neoadjuvant Chemoimmunotherapy versus Neoadjuvant Chemoradiotherapy versus Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma: A Real-World, Three-Arm, Retrospective Cohort Study from the Chinese National Cancer Center.
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Abstract
IntroductionThe optimal neoadjuvant strategy for locally-advanced esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to compare the efficacy and safety of neoadjuvant chemoimmunotherapy (NCIT), chemoradiotherapy (NCRT), and chemotherapy alone (NCT).MethodsWe retrospectively analyzed perioperative clinical data from ESCC patients treated with NCIT, NCRT, or NCT at the National Cancer Center in China from 2009 to 2023. The primary outcomes were pathological response, survival, recurrence pattern and surgical complications.ResultsClinicopathological data from 462 patients (NCIT=122, NCRT=195, NCT=145) were analyzed. The pathological complete response (pCR) rate in the NCIT group (29.5%) was comparable to the NCRT group (28.7%) but significantly higher than the NCT group (3.4%). The overall postoperative complication rate in the NCIT group was higher than in the NCT group (33.6% vs. 14.5%, p<0.001) but comparable to the NCRT group (33.6% vs. 28.2%, p=0.309), with a manageable level. The overall recurrence rates were lower in NCIT (27.0%) than NCRT (48.2%) and NCT (44.1%). Notably, the distant metastasis rate in the NCIT group was significantly lower than that in the NCRT group (11.5% vs. 22.1%, p=0.017) and the NCT group (11.5% vs. 22.8%, p=0.016). As for long-term survival, the 5-year overall survival rate for NCIT was 72.5%, significantly higher than both NCRT (55.7%, p<0.001) and NCT (60.8%, p=0.004). Similarly, the 5-year recurrence-free survival rate for NCIT was 70.7%, significantly surpassing both NCRT (49.8%, p<0.001) and NCT (46.2%, p<0.001). No significant survival differences were observed between the NCRT and NCT groups.ConclusionNCIT provides a significant survival benefit over both NCRT and NCT in locally advanced ESCC in real-world clinical practice, achieving a comparable pCR rate to NCRT and decreased recurrence rate. It's a favorable neoadjuvant option, with the potential to be a novel treatment strategy. Prospective randomized trials to validate our findings are warranted.
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