Abstract
BackgroundCombination of neoadjuvant immunotherapy and chemotherapy (nICT) is a novel treatment for locally esophageal cancer squamous cell carcinoma (ESCC). This study aimed to evaluate the potential effect of nICT on surgery safety by comparing short-term outcomes between the surgery alone group and the nICT followed by surgery group.MethodsA retrospective analysis was performed to identify patients (from January 2017 to July 2021) who underwent surgery for ESCC with or without nICT. A propensity score matching (PSM) comparison (1:1) was conducted to reduce selection biases and balance the demographic and oncologic characteristics between groups.ResultsAfter PSM, the nICT group (n = 38) was comparable to the surgery alone group (n = 38) in the following characteristics: age, sex, BMI, ASA status, smoking, tumor location, lymph node resection, clinical stage, anastomotic location, surgical approach, and surgical approach. The operation time and incidence of postoperative pneumonia in the nICT group were higher than those in the control group (p < 0.05). However, other complications and major complications were comparable between the two groups. There was no significant difference between the two groups in intraoperative blood loss, ICU stay time, postoperative hospital stay, and hospitalization cost. The 30-day mortality, 30-day readmission, and ICU readmission rates were also similar in the nICT and control groups. In the nICT group, the pathological complete response rate in primary tumor was 18.4%, and the major pathological response rate in tumor was 42.1%.ConclusionsBased on our preliminary experience, nICT followed by surgery is safe and effective with acceptable increased operation risk, manageable postoperative complications, and promising pathological response. Further multicenter prospective trials are needed to validate our results.
Highlights
Combination of neoadjuvant immunotherapy and chemotherapy is a novel treatment for locally esophageal cancer squamous cell carcinoma (ESCC)
We chose clinical tumor-lymph node-metastasis (cTNM) stage after neoadjuvant therapy due to two reasons: First, before treatment, most patients in the neoadjuvant immunotherapy and chemotherapy (nICT) group were diagnosed with III or IV cTNM stage, and it is hard to conduct a balanced match with the surgery alone group
The number of removed lymph nodes were more in the nICT group, with a median 35.5 and 30 in the nICT group and surgery alone group, respectively (p = 0.039)
Summary
Combination of neoadjuvant immunotherapy and chemotherapy (nICT) is a novel treatment for locally esophageal cancer squamous cell carcinoma (ESCC). Neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) have been proven to improve long-term survival without additional postoperative morbidity and mortality (5). In Asia, nCT followed by surgery has been advocated as standard treatment for locally advanced ESCC (6). Kamarajah et al reported that compared to nCT, overall survival benefit was evident for nCRT (HR 0.78, 0.62 to 0.97), and recommended nCRT followed by surgery for ESCC (6). A meta-analysis including 4,529 patients (nCT: 2,035; nCRT: 2,494) found that compared to the nCT group, deaths caused by tumor progression or recurrence were significantly less in the nCRT group than in the nCT group; there was not an increase in 5-year survival (7). It is necessary to explore novel treatment regiments to achieve better long-term prognosis (8)
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