Background: Patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) have poor prognosis after surgery. Neoadjuvant chemoimmunotherapy (nCIT) and neoadjuvant chemoradiotherapy (nCRT) may improve outcomes, but their long-term efficacy remains unclear.Methods: This multicenter study analyzed LA-ESCC patients from three Chinese hospitals (2015–2024) who received nCIT or nCRT followed by surgery. Primary endpoint was 3-year overall survival (OS); secondary endpoints included objective response rate (ORR), pathologic complete response (pCR), disease-free survival (DFS), and adverse events. Propensity score matching balanced baseline characteristics.Results: Among 225 patients (87 nCRT, 138 nCIT), matched cohorts (87 per group) showed that nCRT had higher ORR (85.06% vs. 45.98%), T/N downstaging rates (78.16% vs. 58.62%; 85.06% vs. 45.98%), and pCR (37.90% vs. 14.90%) (allp< 0.01). After median follow-up (nCIT: 44.5 months; nCRT: 35.1 months), nCIT improved 3-year OS (75.90% vs. 55.60%) and DFS (66.40% vs. 47.30%) (p< 0.05). Subgroup analysis favored nCRT in N+ or non-cT4 disease. Clinical N stage independently predicted survival.Conclusion: nCIT demonstrates superior survival benefits in LA-ESCC, while nCRT may be more effective for N+ or non-cT4 patients. Further randomized trials are warranted.
背景：局部晚期食管鳞状细胞癌（LA-ESCC）患者术后预后较差。新辅助化疗免疫治疗（nCIT）与新辅助放化疗（nCRT）可能改善疗效，但其长期效果尚不明确。 方法：本多中心研究分析了来自三家中国医院（2015–2024年）接受nCIT或nCRT后行手术治疗的LA-ESCC患者。主要终点为3年总生存期（OS）；次要终点包括客观缓解率（ORR）、病理完全缓解（pCR）、无病生存期（DFS）及不良事件。采用倾向评分匹配平衡基线特征。 结果：在225例患者（nCRT组87例，nCIT组138例）中，匹配队列（每组87例）显示nCRT组具有更高的ORR（85.06% vs. 45.98%）、T/N降期率（78.16% vs. 58.62%；85.06% vs. 45.98%）及pCR率（37.90% vs. 14.90%）（所有p<0.01）。中位随访后（nCIT组：44.5个月；nCRT组：35.1个月），nCIT组改善了3年OS（75.90% vs. 55.60%）和DFS（66.40% vs. 47.30%）（p<0.05）。亚组分析显示nCRT在N+或非cT4疾病中更具优势。临床N分期是生存的独立预测因素。 结论：nCIT在LA-ESCC中显示出更优的生存获益，而nCRT可能对N+或非cT4患者更有效。仍需进一步随机试验验证。
肿瘤(癌症)患者之家