Xu Binwen, Zhang Chengcheng, Luo Tao, Zhang Yue, Zhang Liwen, Shi Guidong, Fu Maoyong
Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, No. 1, Maoyuan South Road, Nanchong, 637000, Sichuan, China.
J Gastrointest Cancer. 2025 Aug 4;56(1):167. doi: 10.1007/s12029-025-01293-x.
While neoadjuvant chemotherapy (NCT) and neoadjuvant immunochemotherapy (NICT) are effective treatments for locally advanced esophageal squamous cell carcinoma (ESCC), comparative analyses of their long-term survival outcomes are scarce. This study aims to evaluate the treatment efficacy, safety, and survival outcomes between NICT and NCT.
This retrospective study included 157 patients with locally advanced ESCC who underwent NCT or NICT followed by surgery at our hospital. To minimize confounding factors, PSM at a 1:1 ratio was conducted.
After PSM, a total of 51 matched pairs of ESCC patients receiving NICT and NCT were included for analysis. The median follow-up was 48.6 months (95% CI, 39.14-58.07). The NICT group showed significantly better overall survival (OS) and disease-free survival (DFS) than the NCT group (3-year OS: 78% vs 57%, P = 0.029; 3-year DFS: 68% vs 43%, P = 0.005). The NICT group achieved significantly higher partial response (PR) rates (78.4% vs 56.9%, P = 0.019) and pathological complete response (pCR) rates (27.5% vs 5.9%, P = 0.013) compared to the NCT group. No significant difference was observed in the overall incidence of treatment-related adverse events and postoperative complications between the two groups. Patients who achieved tumor remission, downstaging, or pCR experienced significantly longer OS and DFS (P < 0.05).
For ESCC, NICT may offer a more sensitive treatment response and higher pathological remission rates than NCT, without increasing the risk of treatment-related adverse events or postoperative complications, indicating superior safety, efficacy, and long-term survival advantages.
虽然新辅助化疗（NCT）和新辅助免疫化疗（NICT）是局部晚期食管鳞状细胞癌（ESCC）的有效治疗方法，但关于它们长期生存结果的比较分析却很少。本研究旨在评估NICT和NCT之间的治疗效果、安全性和生存结果。
本回顾性研究纳入了157例在我院接受NCT或NICT然后进行手术的局部晚期ESCC患者。为尽量减少混杂因素，按1:1的比例进行了倾向评分匹配（PSM）。
经过PSM后，共纳入51对接受NICT和NCT的ESCC匹配患者进行分析。中位随访时间为48.6个月（95%CI，39.14 - 58.07）。NICT组的总生存期（OS）和无病生存期（DFS）明显优于NCT组（3年OS：78%对57%，P = 0.029；3年DFS：68%对43%，P = 0.005）。与NCT组相比，NICT组达到了显著更高的部分缓解（PR）率（78.4%对56.9%，P = 0.019）和病理完全缓解（pCR）率（27.5%对5.9%，P = 0.013）。两组之间治疗相关不良事件和术后并发症的总体发生率没有显著差异。实现肿瘤缓解、降期或pCR的患者经历了明显更长的OS和DFS（P < 0.05）。
对于ESCC，NICT可能比NCT提供更敏感的治疗反应和更高的病理缓解率，而不会增加治疗相关不良事件或术后并发症的风险，表明其具有卓越的安全性、疗效和长期生存优势。
