Multicenter retrospective study of three-year outcomes of neoadjuvant chemoimmunotherapy versus chemoradiotherapy for esophageal cancer

Patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) have poor prognosis after surgery. Neoadjuvant chemoimmunotherapy (nCIT) and neoadjuvant chemoradiotherapy (nCRT) may improved outcomes, but their long-term efficacy remains unclear. A retrospective study at three hospitals in China investigated 3-year outcomes of LA-ESCC patients who received nCIT or nCRT followed by surgery. Among 225 patients (87 nCRT, 138 nCIT), matched cohorts (87 per group) showed that nCRT had higher ORR (85% versus 46%), T/N downstaging rates (78% versus 59%), and pCR (38% versus 15%) (all p<0.001). However, nCIT improved 3-year OS and DFS compared with nCRT. Subgroup analysis favored nCRT in N+ or non-cT4 diease. The authors conclude that nCIT demonstrated superior survival benefits over nCRT in LA-ESCC, while nCRT may be more effective for N+ or non-cT4 patients.