Superior Prognosis of Neoadjuvant Immunochemotherapy over Neoadjuvant Chemoradiotherapy in Esophageal Squamous Cell Carcinoma Patients with pCR.

Background

Neoadjuvant chemoradiotherapy (NCRT) is the standard regimen for locally advanced esophageal squamous cell carcinoma (ESCC), while neoadjuvant immunochemotherapy (NICT) has emerged as a promising alternative. Achieving pathological complete response (pCR) after neoadjuvant therapy is associated with favorable prognosis, yet whether the modality used to achieve pCR influences long-term outcomes remains unclear.

Methods

We retrospectively analyzed 332 ESCC patients who attained pCR following neoadjuvant therapy (220 in the NCRT group and 112 in the NICT group). Prognostic outcomes, including short-term clinical outcomes, long-term survival, and recurrence patterns, were compared between the two groups.

Results

Among all pCR patients, the NCRT group exhibited a significantly higher incidence of postoperative pneumonia compared with the NICT group (28.6% vs. 14.3%, P = 0.004). Regarding recurrence patterns, the NCRT group showed higher rates of both local and distant recurrence. After multivariable adjustment, NICT conferred superior overall survival (OS) (HR = 0.248, 95% CI: 0.076-0.809, P = 0.021) and disease-free survival (DFS) (HR = 0.215, 95% CI: 0.077-0.599, P = 0.003) relative to NCRT.

Conclusions

Among ESCC patients achieving pCR after neoadjuvant therapy, NICT was associated with significantly better OS and DFS, as well as a lower incidence of postoperative pneumonia, compared with NCRT. Given its survival benefit and favorable safety profile, NICT may be a preferred neoadjuvant strategy for selected patients, pending prospective corroboration.