183. NEOADJUVANT CAMRELIZUMAB PLUS CHEMOTHERAPY (NICE) VERSUS CROSS REGIMENS IN OESOPHAGEAL SQUAMOUS CELL CARCINOMA, A PROPENSITY-SCORE MATCHED ANALYSIS

Abstract

Abstract Background The CROSS regimen represents standard neoadjuvant management for oesophageal squamous cell carcinoma (ESCC) for the last decade, while the utility of Camrelizumab plus chemotherapy (NICE) is increasingly gaining attention. In the absence of published Randomized Controlled Trials, there remains a paucity of robust information on comparison of these two modalities. This study aims to compare the treatment response and short-term outcomes of NICE followed by oesophagectomy with that after CROSS-induced chemoradiotherapy, in treatment for ESCC. Methods A total of 234 patients staged as clinical II-IV, 117 in each arm, was enrolled in this study after propensity-score match. The primary outcomes were tumor response and survival. Secondary outcomes were toxicity and postoperative complications. Pathological response of tumor was evaluated by Chirieac tumor regression grade (TRG) and major pathological response (MPR) as well as responders were defined as TRG1–2 N0. Complications were defined as per the Esophageal Complications Consensus Group (ECCG) criteria and severity per Clavien-Dindo. Survival was evaluated by Kaplan–Meier method using Breslow test, and freedom from recurrence with the competing risk of death estimated per Fine-Gray method. Results After matching, R0 resection (93.2% vs 94.9%, P = 0.784), pCR (ypT0N0) (25.6% vs 30.8%, P = 0.468), MPR (46.2% vs 47.0%, P = 0.896) rates and TRG1/2 grades (P = 0.331) were comparable between CROSS and NICE regimens. However, NICE was associated with more lymph nodes yield (P < 0.001) and higher risk of anastomotic leak (type2/3) (P = 0.030)(Fig. 1A-C). The 1-year overall survival was 86.6% and 93.5% for CROSS and NICE (P = 0.088) with comparable recurrence risk (21% vs 21%, P = 0.520) (Fig. 1D/E). Patients with pCR or responders showed similar K-M curves, but in nonresponder subgroup analysis, NICE regimen demonstrated superior survival benefit than CROSS (P = 0.035) (Fig. 1F-H). Conclusion In this matched study, NICE is safe and feasible for ESCC with comparable perioperative outcomes compared to CROSS. Moreover, NICE regimen shows superior survival benefit in nonresponder group than CROSS, suggesting its more powerful systemic treatment effects. However, Prospective RCT studies are needed to further verify these findings.