The comparisons of neoadjuvant chemoimmunotherapy versus chemoradiotherapy for oesophageal squamous cancer

Abstract

Objectives To evaluate the short-term outcomes of neoadjuvant chemoimmunotherapy followed by oesophagectomy for locally advanced oesophageal squamous carcinoma. Methods Patients receiving neoadjuvant chemoimmunotherapy or chemoradiotherapy between September 2019 and September 2021 were identified. The primary outcomes were tumour response and survival. Secondary outcomes were toxic effects and postoperative complications. The propensity score matching for enrolled patients was performed. Results Data of 149 patients with clinical stage II-IV oesophageal squamous cancer, including 55 receiving neoadjuvant chemoimmunotherapy and 94 receiving neoadjuvant chemoradiotherapy, were analyzed after propensity score matching. With regard to tumour response score, 24 (43.6%) and 59 (62.8%) patients were scored 0/1 in the neoadjuvant chemoimmunotherapy and neoadjuvant chemoradiotherapy groups, respectively (p = 0.023). Of note, 17 (30.9%) patients in the neoadjuvant chemoimmunotherapy group achieved pathological complete response (ypT0N0), while 48 (51.1%) patients in neoadjuvant chemoradiotherapy group achieved pathological complete response (P = 0.026). Neoadjuvant chemoradiotherapy was associated with higher risk of postoperative pneumonia (p = 0.034) and less lymph nodes and stations dissected (p ≤ 0.001). The 1-year cumulative overall survival rate was 94.5% and 86.2% in the NACI and NACR groups, respectively (p = 0.170). Conclusions We found that neoadjuvant chemoimmunotherapy compared with neoadjuvant chemoradiotherapy was associated with lower pneumonia rate and was safe and feasible for locally advanced oesophageal squamous cancer. However, the tumour regression score and the pathological complete response rate of patients treated with neoadjuvant immunotherapy was lower than those of patients treated with neoadjuvant chemoradiotherapy. The short-term follow-up results were comparable between two treatment modalities.

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

“…In this study, the 1-year OS rate in the nCIT group were 82.4%, consistent with the 1-year OS of between 87.6% and 92.8% in previous reports ( 29 , 39 ), but not significantly different from nCT (77.3%) and nCRT (83.9%). In a few propensity score matching analyses, the 1-year OS rate in the nCIT group was 94.5-95.7%, slightly better than 84.8% in the nCT group and 86.2% in the nCRT group, but with no significant statistical differences ( 40 , 41 ). Although no statistically significant difference was observed in our data, the 3-year OS after nCIT was 73.3%, slightly higher than 46.1% after nCT and 39.7% after nCRT.…”

“…In certain propensity score matching analyses by Hong et al. and Xiao et al, esophagectomy after nCIT required shorter operative times, and dissected more lymph nodes than after nCRT ( 41 , 43 ). Cheng et al.…”

“…Based on our surgical experience, mild or moderate tissue adhesions were more frequently observed in the nCIT group compared to the nCRT group, which might help reduce the intraoperative difficulties. In certain propensity score matching analyses by Hong et al and Xiao et al, esophagectomy after nCIT required shorter operative times, and dissected more lymph nodes than after nCRT (41,43). Cheng et al also reported that the nCIT group had minimal intraoperative blood loss, shorter operative times, and fewer perioperative complications than the nCRT group (37).…”

Radiotherapy combined with immune checkpoint inhibitors in locally advanced/metastatic esophageal squamous cell carcinoma: clinical trials, efficacy and future directions

“…With the evolution of anti-tumor drugs, there has been a growing interest in investigating the potential of drug therapy to replace radiotherapy or surgery. However, previous clinical trials have shown that the pCR rate of neoadjuvant immunochemotherapy typically ranges between 25-45% ( 156 – 164 ), which was lower compared to conventional chemoradiotherapy ( 165 ). The pCR rate of neoadjuvant chemoradiotherapy combined with ICI is mostly above 45%, with the highest rate of 55.6% observed in the PALACE-1 study ( 35 ).…”

Confounding adjustment in observational studies on cardiothoracic interventions: a systematic review of methodological practice

“…In the studies that used matching without replacement, on average 78% of the treated patients and 38% of the untreated remained in the analysis. The 2 studies that used replacement [ 15 , 16 ] did not report the number of unique individuals that remained in the analysis.…”