Neoadjuvant PD-1 blockade combined with chemotherapy or chemotherapy alone for patients with resectable locally advanced esophageal carcinoma: A real-world data analysis

Abstract

Background Neoadjuvant concurrent chemoradiotherapy with surgery was the standard of therapy for esophageal cancer. But many patients refused or abandoned radiotherapy because of the intolerable adverse effects in China. Neoadjuvant immunochemotherapy (nICT) followed by surgery has become an emerging treatment in patients with esophageal cancer. There was still no consensus on whether neoadjuvant immunochemotherapy was superior to neoadjuvant chemotherapy (nCT) alone in patients with esophageal cancer. Methods In this retrospective study, patients with resectable esophageal cancer received surgery after neoadjuvant immunochemotherapy (nICT) (n = 26, 40%) or neoadjuvant chemotherapy (nCT) alone (n = 39, 60%) were included. The patients were classified as nICT or nCT arm. The primary end points were pathological tumor response (PTR) and event-free survival (EFS). The different clinic-pathological features were compared by the Kruskal-Wallis test for continuous variables and the Chi-square (χ2) test for categorical variables. Kaplan-Meier curves were used to estimate EFS from the date of treatment to recurrence or death. All tests were 2-sided with a significative P-value defined < .05. Results Three (11.5%) of the 26 patients achieved pathological complete remission (pCR) in the nICT group, and four (10.3%) of the 39 patients achieved pCR in the nCT group, respectively (P = 1.0). Six (23.1%) of the 26 patients achieved major pathological response (MPR) in the nICT group, and eleven (28.2%) of the 39 patients achieved MPR in the nCT group, respectively (P = 0.645). Downstaging was achieved in 13 (44.8%) patients in the nICT group and 16 (55.2%) patients in the nCT group, respectively (P = 0.732). To verify the TRG results, we compared them with MPR and pCR, which showed a significant dependency (P < 0.001). Patients who achieved downgrading showed better MPR and pCR rates (P<0.001 and P = 0.010). There was no significant difference in EFS between nICT and nCT group (HR = 1.011, 95%CI: 0.421–2.425, P = 0.981). Conclusions