Efficacy of neoadjuvant chemoimmunotherapy in locally advanced resectable esophageal cancer.

Abstract

Objective: To evaluate the efficacy and safety of neoadjuvant chemoimmunotherapy (NICT) in treating locally advanced resectable esophageal squamous cell carcinoma (ESCC).

Materials and methods: This retrospective analysis included 379 patients, who received NICT (PD-1 inhibitors + chemotherapy) before surgery at Shandong Cancer Hospital from January 1, 2020, to January 1, 2025. Pathological responses were assessed using standardized criteria, including pathological complete response (pCR), major pathological response (MPR), and tumor regression grade (TRG). Survival analysis was performed using Kaplan-Meier methods, and multivariate Cox regression models were constructed to evaluate the relationship between NICT and survival outcomes.

Results: The pCR, MPR, and significant tumor reduction rates were 27.2%, 41.8%, and 81.6%, respectively. Poor tumor differentiation and early clinical stage were associated with improved treatment responses. Patients achieving pCR, MPR, or TRG0-1 had significantly better overall survival rates compared with other groups (P < 0.0001). NICT demonstrated acceptable toxicity, with anastomotic leakage (9.0%) and pneumonia (17.9%) being the primary complications.

Conclusion: NICT significantly improves pathological response and survival rates in patients with locally advanced resectable ESCC, with a favorable safety profile. These findings highlight the potential of NICT to transform the treatment landscape of ESCC. Future research should focus on the optimizing treatment regimens, identifying predictive biomarkers, and reducing toxicity to improve clinical outcomes and achieve personalized treatment.