Abstract 406P
Background
Neoadjuvant chemoradiotherapy （nCRT） followed by esophagectomy is the standard treatment for locally advanced esophageal Squamous Cell Carcinoma (LA-ESCC). However, it is unclear whether neoadjuvant chemotherapy combined with immunotherapy （nCIT） further improves survival compared to nCRT.
Methods
Clinical data of patients who received nCIT or nCRT followed by esophagectomy for LA-ESCC between January 2010 and December 2022 were retrospectively collected from Zhejiang Cancer Hospital. The primary endpoint was overall survival (OS), secondary endpoints were clinicopathologic response, disease-free survival (DFS) and recurrence patterns. Treatment outcomes were compared between the two groups using univariate and multivariate Cox-regression analyses based on propensity score matching for baseline characteristics.
Results
A total of 625 patients were enrolled (470 in nCIT group and 155 in nCRT group). After two-to-one propensity score matching, 358 patients were included for analysis. The nCIT group had higher 3-year OS rate (77.6% vs. 62.2%, p=0.002) and 3-year DFS rate (69.4% vs. 53.5%, p=0.003) than nCRT group. After adjusting for other confounders in the multivariate analysis, nCIT remained a significantly favorable factor for both OS (HR 0.564, 95%CI 0.351-0.906, p=0.018) and DFS (HR 0.479, 95%CI 0.328-0.699, p<0.001). 93.7% of patients in the nCIT group achieved R0 resection compared to 94.1% in the nCRT group (p=0.893); pathologic complete response (pCR) rate was reported in 17.0% versus 38.5% (p<0.001) of patients, respectively. The major recurrence pattern was locoregional recurrence (12.3%) in the nCIT group, while distant metastasis (17.3%) in the nCRT group. Patients in the nCRT group were more likely to developing distant relapse (17.3% vs. 5.7%, p<0.001).
Conclusions
This retrospective analysis suggests that nCIT may improve OS and DFS over nCRT in LA-ESCC, even with lower rate of pCR, and prospective studies are needed to further confirm its efficacy.
Legal entity responsible for the study
The authors.
Funding
Medical Science and Technology Project of Zhejiang Province (No. 2021KY542).
Disclosure
All authors have declared no conflicts of interest.