Abstract:

Objective To analyze the real clinical effects and prognosis of neoadjuvant therapy for locally advanced resectable esophageal cancer. Methods Two hundred and one patients with locally advanced resectable esophageal cancer who underwent different neoadjuvant treatments at Nanchong Central Hospital of Sichuan Province from January 2019 to December 2021 were retrospective analyzed. Patients were divided into neoadjuvant chemoradiotherapy group （n=87）， neoadjuvant immunochemotherapy group （n=69）， and neoadjuvant chemotherapy group （n=45） according to the different methods of neoadjuvant therapy. Patients underwent surgical treatment 4-6 weeks after completing neoadjuvant therapy. The postoperative pathological response of three groups of patients were compared. Kaplan-Meier method was used to draw survival curves. Log-rank tests were performed to analyze overall survival （OS） rate， local recurrence-free survival （LRFS） rate， and distant metastasis-free survival （DMFS） rate in three groups of patients. Results The pathological complete response rates of the neoadjuvant chemoradiotherapy group， neoadjuvant immunochemotherapy group and neoadjuvant chemotherapy group were 33.3% （29/87）， 40.6% （28/69） and 13.3% （6/45）， respectively， with a statistically significant difference （χ²=9.68， P=0.008）. The pathological complete response rates in the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were higher than that in the neoadjuvant chemotherapy group， with statistically significant differences （χ²=6.09， P=0.014； χ²=9.66， P=0.002）； there was no statistically significant difference between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group （χ²=0.87， P=0.351）. The major pathologic response rates of the three groups were 58.6% （51/87）， 59.4% （41/69） and 31.1% （14/45）， respectively， with a statistically significant difference （χ²=10.89， P=0.004）. The major pathologic response rates of the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were significantly higher than that of the neoadjuvant chemotherapy group， with statistically significant differences （χ²=8.98， P=0.003； χ²=8.74， P=0.003）； there was no statistically significant difference between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group （χ²=0.10， P=0.920）. The 3-year OS rates of the three groups were 43.7%， 42.0% and 33.3%， respectively， with no statistically significant difference （χ²=0.79， P=0.347）. The 3-year LRFS rates of the three groups were 67.8%， 66.7% and 46.7%， respectively， with a statistically significant difference （χ²=7.58， P=0.023）， the LRFS rates in the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were significantly higher than that in the neoadjuvant chemotherapy group， with statistically significant differences （χ²=4.17， P=0.041； χ²=4.15， P=0.042）； there was no statistically significant difference in LRFS rates between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group （χ²=0.01， P=0.923）. The 3-year DMFS rates of the three groups were 37.9%， 37.7% and 28.9%， respectively， with no statistically significant difference （χ²=0.14， P=0.707）. Conclusion Different neoadjuvant therapies have different therapeutic effects in the treatment of locally advanced resectable esophageal cancer， neoadjuvant chemoradiotherapy and neoadjuvant immunochemotherapy can achieve a better pathological response rates and LRFS rates.

Key words: Esophageal neoplasms, Chemoradiotherapy, Prognosis, Neoadjuvant therapy, Immunotherapy, Pathological response