Patients with Upper Third of Esophageal Squamous Cell Carcinoma Have Better Tumor Regression After Neoadjuvant Immunochemotherapy.

Abstract

Background: Several high-quality clinical trials have shown promising results compared with neoadjuvant chemotherapy (NCT) or chemoradiotherapy, further supporting the efficacy of neoadjuvant immunochemotherapy (NICT) for locally advanced esophageal cancer (AEC). This study evaluated the efficacy of NICT in different segments of esophageal squamous cell carcinoma (ESCC) and aimed to identify potential prognostic factors.

Methods: A retrospective cohort study analyzed 248 patients. Before undergoing radical surgery, the patients received two to four cycles of NICT. The relationship between different segments of ESCC and both clinical and pathologic characteristics were evaluated.

Results: The patients with tumors in the upper thoracic esophagus had a higher proportion of lower tumor regression grade (TRG) scores. A significantly higher proportion of patients with TRG 0-1 was observed in the upper and middle thoracic tumor groups than in the lower thoracic group (P = 0.001). In esophageal cancer, TRG 2-3 was significantly associated with lower thoracic tumor location (odds ratio [OR], 3.298; P = 0.003), clinical T3 stage (OR, 2.834; P < 0.001), and clinical N2 stage (OR, 2.557; P = 0.045).

Conclusions: The patients with upper-third ESCC appeared to derive greater clinical benefits from NICT than those with tumors located in the lower third of the esophagus in this post hoc analysis. This could potentially serve as a predictor of NICT efficacy.