Perioperative outcomes of neoadjuvant chemotherapy plus camrelizumab compared with chemotherapy alone and chemoradiotherapy for locally advanced esophageal squamous cell cancer

Abstract

PurposeNeoadjuvant chemoimmunotherapy (nCIT) is becoming a new therapeutic frontier for resectable esophageal squamous cell carcinoma (ESCC); however, crucial details and technical know-how regarding surgical techniques and the perioperative challenges following nCIT remain poorly understood. The study investigated and compared the advantages and disadvantages of esophagectomy following nCIT with neoadjuvant chemotherapy (nCT) and chemoradiotherapy (nCRT).MethodsWe retrospectively analyzed data of patients initially diagnosed with resectable ESCC at clinical stage T2-4N+ and received neoadjuvant therapy followed by esophagectomy at the Hunan Cancer Hospital between October 2014 and February 2021. Patients were divided into three groups according to neoadjuvant treatment: (i) nCIT; (ii) nCT; and (iii) nCRT.ResultsThere were 34 patients in the nCIT group, 97 in the nCT group, and 31 in the nCRT group. Compared with nCT, nCIT followed by esophagectomy achieved higher pathological complete response (pCR; 29.0% versus 4.1%, p<0.001) and major pathological response (MPR; 52.9% versus 16.5%, p<0.001) rates, more resected lymph nodes during surgery (25.06 ± 7.62 versus 20.64 ± 9.68, p=0.009), less intraoperative blood loss (200.00 ± 73.86 versus 266.49 ± 176.29 mL, p=0.035), and comparable results in other perioperative parameters. Compared with nCRT, nCIT achieved similar pCR (29.0% versus 25.8%) and MPR (52.9% versus 51.6%, p=0.862) rates, with significantly more lymph nodes resected during surgery (25.06 ± 7.62 versus 16.94 ± 7.24, p<0.001), shorter operation time (267.79 ± 50.67 versus 306.32 ± 79.92 min, p=0.022), less intraoperative blood loss (200.00 ± 73.86 versus 264.53 ± 139.76 mL, p=0.022), and fewer ICU admissions after surgery (29.4% versus 80.6%, p<0.001). Regarding perioperative adverse events and complications, no significant statistical differences were detected between the nCIT and the nCT or nCRT groups. The 3-year overall survival rate after nCIT was 73.3%, slightly higher than 46.1% after nCT and 39.7% after nCRT, with no statistically significant differences (p=0.883).ConclusionsThis clinical analysis showed that nCIT is safe and feasible, with satisfactory pCR and MPR rates. Esophagectomy following nCIT has several perioperative advantages over nCT and nCRT, with comparable perioperative morbidity and mortality. The long-term survival benefits after nCIT still requires further investigation.

Neoadjuvant chemoimmunotherapy for locally advanced esophageal squamous cell carcinoma: Data from literature review and a real‐world analysis

“…NCIT did not increase surgical difficulty in our cases, and there were no surgical complications that resulted in death. Zhang et al 38 found that compared to nCRT, nCIT achieved comparable pCR and MPR rates, but with significantly more lymph nodes removed during surgery, shorter operation time, reduced intraoperative blood loss, and fewer ICU admissions post‐surgery.…”

Present situation and prospect of immunotherapy for unresectable locally advanced esophageal cancer during peri-radiotherapy

“…Research of neoadjuvant chemotherapy combined with immunotherapy for resectable esophageal cancer has made some progress[ 15 ], which shows that neoadjuvant chemotherapy combined with immunotherapy has a high pathological complete response (pCR) rate, which gives a new option for the treatment of locally advanced esophageal cancer. Most clinical studies of neoadjuvant chemotherapy combined with immunotherapy are phase I/II studies, among which the typical one was the National Institute for Health and Care Excellence (NICE) study reported at the European Society for Medical Oncology conference in 2020[ 16 ].…”

Survival outcomes of neoadjuvant immunochemotherapy versus chemotherapy for locally advanced esophageal squamous cell carcinoma

“…Several studies have demonstrated that NICT produced a higher pathological complete response (pCR) rate ranging from 21.7% to 50% with manageable toxicity profile (Zhang et al 2021 ; Yang et al 2022 ; Liu et al 2022a , b . Lv et al 2022 , 2023 ; Yan et al 2022 ; Liu et al 2022a , b ; Zhang et al 2022b ; Chen et al 2023b ; Zhang et al 2023a , b ; Yang et al 2023 ; Yin et al 2022 ; Wang et al 2023 ; Shen et al 2021 ). However, few studies have compared the efficacy and safety of NICT and NCT alone, especially survival outcomes.…”