Abstract
BackgroundImmunotherapy has become a pillar of advanced solid tumors treatment. Patients are more likely to benefit from neoadjuvant immunotherapy compared with traditional neoadjuvant therapy. However, the safety and efficacy of neoadjuvant immunotherapy for the treatment of locally advanced, surgically resectable Esophageal squamous cell carcinoma (ESCC) remain unknown.MethodESCC patients who received neoadjuvant treatment following minimally invasive esophagogastrostomy were enrolled from June 2020 to September 2021. The characteristics of neoadjuvant treatment and surgery were investigated to determine the safety and efficacy of the neoadjuvant combination of chemotherapy and immunotherapy (NCI).ResultsA total of 149 patients were included in the study. Patient ratio was 40:109 between NCI and neoadjuvant chemotherapy plus radiotherapy (NCR) groups. No significant difference was found in terms of pathological characteristics, including ypN stage, ypTNM stage, differentiation, lymphovascular invasion, perineural invasion, pathological complete regression and tumor regression score, and these parameters were not correlated with NCI or NCR (all p>0.05). Regarding to the operation, the NCI group had less blood loss (49.25 ± 13.47 vs. 57.02 ± 47.26, p<0.001), and shorter operation time (247.75 ± 28.28 vs. 285.83 ± 52.43, p<0.001) than the NCR group. Additionally, the NCI group demonstrated a lower rate of overall perioperative complications (p=0.003) and grade >2 perioperative complications (p=0.042) than the NCR group.ConclusionOverall, the findings reported here indicate NCI could result in better outcome and less complications to locally advanced ESCC patients compared with NCR therapy. As a novel therapeutic option, the efficacy and safety of NCI appears to be feasible and safe, while long-term survival data is still needed.
Highlights
Esophageal cancer, a life-threatening disease, has become the 5th leading cause of death worldwide, of which 5-year survival remains approximately 15–25% due to its high malignant potential and poor prognosis [1–4]
Consecutive Esophageal squamous cell carcinoma (ESCC) patients who received neoadjuvant chemotherapy combined with immunotherapy (NCI) or neoadjuvant chemotherapy combined with radiotherapy (NCR) following minimally invasive esophagogastrostomy (MIE) from January 2020 to May 2021 were retrieved from the esophageal cancer database of West China Hospital
193 were classified as ESCC; 149 received neoadjuvant treatment followed by MIE, 40 received neoadjuvant chemotherapy plus immunotherapy (NCI), and 109 received neoadjuvant chemotherapy plus radiotherapy (NCR)
Summary
Esophageal cancer, a life-threatening disease, has become the 5th leading cause of death worldwide, of which 5-year survival remains approximately 15–25% due to its high malignant potential and poor prognosis [1–4]. Surgery alone is frequently accompanied by high recurrence or metastasis rates leading to poor survival and limited progress among patients with locally advanced esophageal cancer [5, 6]. The treatment of esophageal cancer has evolved into a new multidisciplinary process so as to improve long-term survival of patients. Despite the fact that patients are more likely to benefit from neoadjuvant immunotherapy compared with traditional neoadjuvant therapy [15, 16], the safety and efficacy of immunotherapy for locally advanced, surgically resectable esophageal cancer has not been evaluated comprehensively yet. The safety and efficacy of neoadjuvant immunotherapy for the treatment of locally advanced, surgically resectable Esophageal squamous cell carcinoma (ESCC) remain unknown
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