Neoadjuvant immunochemotherapy in locally advanced esophageal squamous cell carcinoma: a retrospective study with 2-year survival analysis

Background Neoadjuvant immunochemotherapy (NICT) has shown encouraging short-term outcomes in patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC), but data on long-term survival remain limited. This study compared the therapeutic efficacy, safety, and 2-year survival outcomes of NICT versus surgery alone. Methods We retrospectively analyzed patients with locally advanced resectable ESCC who underwent either NICT followed by surgery or upfront surgery alone. Primary endpoints were disease-free survival (DFS) and overall survival (OS). Results A total of 188 patients were included, with 60 receiving NICT and 128 undergoing surgery alone. The NICT group achieved better 2-year DFS (76.7% vs. 57.0%, P = 0.021) and OS (86.7% vs. 68.0%, P = 0.0053), with similar rates of postoperative complications (40.0% vs. 37.5%, P = 0.742). No >= grade 3 postoperative complications occurred in the NICT group, while three cases (2.3%) were observed in the surgery-alone group. Pathological responses to NICT included 28.3% complete response (pCR) and 61.7% major response (MPR). Grade 3 treatment-related adverse events occurred in 20.0% of NICT patients, with no grade >= 4 events. Patients achieving pCR or MPR had significantly better survival outcomes than non-responders. Survival outcomes were similar between 2-cycle and > 2-cycle NICT regimens. ECOG performance status, coronary artery disease, and treatment modality were identified as independent prognostic factors. Conclusion NICT followed by surgery demonstrated favorable pathological response and 2-year survival outcomes in locally advanced ESCC, supporting its potential as a neoadjuvant strategy pending further prospective validation.