20. ADDITIONAL NEOADJUVANT IMMUNOTHERAPY DOESN’T INCREASE THE RISK OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: A MULTICENTER RETROSPECTIVE COHORT STUDY

Abstract

Abstract Background Neoadjuvant chemoimmunotherapy (nICT) is a promising therapy model for locally advanced esophageal squamous cell carcinoma (LA-ESCC), which brought good pathological response. However, there is still a lack of large cohot to confirm the impact of additional impact of additional neoadjuvant immunotherapy on short-term outcomes. The objective of this study lies on assessing the additional neoadjuvant immunotherapy making a difference in patients’ short-term outcomes, particularly the risk of anastomotic leakage (AL) and pathological response. Methods Patients with LA-ESCC who received neoadjuvant chemotherapy(nCT)/nICT combination with radical esophagectomy were enrolled from three medical centers in China. Baseline data were matched using propensity score matching (1:1, caliper = 0.01) and inverse probability processing weighting(IPTW). Conditional logistic regression and weighted logistic regression analysis were used to further evaluate whether additional neoadjuvant immunotherapy would increased the risk of postoperative AL. Results A total of 331 patients LA-ESCC receiving nCT or nICT were enrolled. The application of PSM as well as IPTW ensured baseline data equilibrium. After matching, there were no significant difference in the AL incidence between the two groups (p = 0.68, after PSM; p = 0.97 after IPTW), and the incidence of AL was 15.85% vs. 18.29%, and 14.79% vs. 15.01%, respectively. Weighted logistic regression analysis showed that additional neoadjuvant immunotherapy wasn’t responsible for AL. The nICT group had dramatically higher pCR in primary tumor than the nCT group (9.76% vs. 28.05% after PSM and 7.72% vs. 21.17% after IPTW). Conclusions Additional neoadjuvant immunotherapy can benefit pathological reactions without increasing the risk of AL and pulmonary complications. We require further randomized controlled research to validate whether additional neoadjuvant immunotherapy would make a difference in other complications, and determine whether pathologic benefits could translate into prognostic benefits, which would require longer follow-up.