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.