Objective: To compare the clinical efficacy of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemo-immunotherapy (nCIT) for locally advanced esophageal squamous cell carcinoma (ESCC). Methods: Clinical data of patients who received nCRT or nCIT followed by esophagectomy for locally advanced ESCC between January 2010 and December 2022 were retrospectively collected from Zhejiang Cancer Hospital, with 155 patients in the nCRT group and 470 patients in the nCIT group. Propensity score matching (PSM) was performed in the two groups. After PSM, 120 patients were allocated to the nCRT group and 192 patients to the nCIT group. The pathological response and disease recurrence were compared between the two groups after PSM. Log rank test were used to compare the survival outcomes before and after PSM. Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors for locally advanced ESCC. Results: After PSM, the R0 resection rate in the nCRT group and the nCIT group was 93.3% (112/120) and 93.8% (180/192), respectively, with no statistical significance (P=0.884). However, the pathological complete response rate in the nCRT group [36.7% (44/120)] was higher than that in the nCIT group [21.4% (41/192), P=0.003]. For patients with R0 resection, the major recurrence pattern was distant metastasis [18.8% (21/112)] in the nCRT group, while the pattern was locoregional recurrence [12.2% (22/180)] in the nCIT group. The 3-year disease-free survival rates were 52.7% and 66.1% (P=0.022) and the 3-year overall survival rates were 59.2% and 75.5% (P=0.002) in the nCRT and nCIT groups, respectively. Multivariate Cox regression analysis also revealed that the neoadjuvant therapy mode was an independent prognostic factor for patients with locally advanced ESCC. Compared with nCRT, nCIT could significantly prolong disease-free survival (HR=0.58, 95% CI: 0.40-0.86) and overall survival (HR=0.53, 95% CI: 0.35-0.79). Conclusion: These results suggest that nCIT could significantly improve disease-free survival rate and overall survival rate over nCRT in locally advanced ESCC, even with lower pathological complete response rate.
目的： 比较新辅助放化疗（nCRT）与新辅助化疗联合免疫（nCIT）治疗局部进展期食管鳞状细胞癌（ESCC）的疗效。 方法： 回顾性收集2010年1月至2022年12月于浙江省肿瘤医院接受nCRT或nCIT后行根治性食管癌切除术的局部进展期ESCC患者的临床资料，nCRT组155例，nCIT组470例。对两组患者进行倾向性评分匹配（PSM），PSM后，nCRT组120例，nCIT组192例。比较PSM后两组的病理退缩反应和复发情况。采用Log rank检验比较PSM前后两组患者的生存率，采用单因素和多因素Cox回归分析明确局部进展期ESCC患者的预后影响因素。 结果： PSM后，nCRT组和nCIT组的R0切除率分别为93.3%（112/120）和93.8%（180/192），差异无统计学意义（P=0.884），但nCRT组的病理完全缓解（pCR）率［36.7%（44/120）］高于nCIT组［21.4%（41/192），P=0.003］。在获得R0切除的患者中，nCRT组的复发模式以远处转移为主，发生率为18.8%（21/112）；nCIT组以局部区域复发为主，发生率为12.2%（22/180）。nCRT组和nCIT组患者的3年无病生存率分别为52.7%和66.1%（P=0.022），3年总生存率分别为59.2%和75.5%（P=0.002），nCIT组患者远期生存获益更为显著。多因素Cox回归分析也显示，新辅助治疗方法是局部进展期ESCC患者预后的独立影响因素，相对于nCRT，nCIT能使患者的无病生存时间（HR=0.58，95% CI：0.40～0.86）和总生存时间（HR=0.53，95% CI：0.35～0.79）显著获益。 结论： 与nCRT相比，nCIT未能获得更高的病理完全缓解率，但可显著提高局部进展期ESCC患者的无病生存率和总生存率。.