Outcomes of neoadjuvant immunochemotherapy and neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma

Background: Esophageal squamous carcinoma is a prevalent cancer worldwide, particularly in China. Few studies have compared the treatment effects of neoadjuvant immunochemotherapy and neoadjuvant chemoradiotherapy on the long-term prognosis of patients with esophageal squamous carcinoma. This study analyzed the 3-year overall survival rate of patients with locally advanced esophageal squamous carcinoma treated with esophagectomy after neoadjuvant immunochemotherapy or neoadjuvant chemoradiotherapy. Methods: A total of 309 patients with esophageal squamous carcinoma who underwent neoadjuvant chemoradiotherapy between 2010 and 2020 and 88 who underwent neoadjuvant immunochemotherapy between 2019 and 2020 at Zhejiang Cancer Hospital were included in this study. Propensity score matching with a 1:1 ratio and a caliper of 0.02 was used to balance the baseline characteristics. Results: The study included 397 patients with locally advanced thoracic segmental esophageal squamous carcinoma, including 88 who received neoadjuvant immunochemotherapy and 309 who received neoadjuvant chemoradiotherapy. After propensity score matching, there were no significant differences in pathologic complete response between the 2 groups (21.3% vs 33.3%, c2 = 2.148, P = .143), and the neoadjuvant immunochemotherapy group demonstrated a greater 3-year overall survival rate (73.8% vs 54.8%, P = .003), particularly for patients with a primary stage III diagnosis (T3N1M0, T1e3N2M0) or an initial suspicion of lymph node metastases. Pathologic complete response emerged as a reliable predictor of long-term outcomes in patients receiving neoadjuvant chemoradiotherapy, but not in those receiving neoadjuvant immunochemotherapy. Conclusion: Neoadjuvant immunochemotherapy was associated with improved long-term prognosis in patients with a primary stage III diagnosis or an initial suspicion of lymph node metastases. Neoadjuvant immunochemotherapy plus surgery emerged as an effective therapeutic strategy for treating locally advanced thoracic segmental esophageal squamous carcinoma. (c) 2025 Published by Elsevier Inc.