Abstract:

Objective To analyze the short-term efficacy and safety of tislelizumab combined with neoadjuvant chemotherapy in the treatment of resectable esophageal squamous cell carcinoma （ESCC）. Methods The clinical data of 56 patients with ESCC who received neoadjuvant therapy combined with surgical resection in the Department of Thoracic Surgery， Affiliated Hospital of Guangdong Medical University from April 2021 to October 2023 were collected. According to the different preoperative neoadjuvant therapy methods， the patients were divided into neoadjuvant chemotherapy combined with immunotherapy group （chemoimmunization group， n=24） and neoadjuvant chemotherapy group （chemotherapy group， n=32）. The postoperative tumor regression grade， objective response rate （ORR）， disease control rate （DCR）， pathological complete response （pCR） rate， major pathological remssion （MPR） rate， R0 resection rate， perioperative indicators， and security were compared between the two groups. Results In chemoimmunization group， the tumor regression grade was better than that in chemotherapy group， with a statistically significant difference （Z=9.39， P=0.025）. The ORR and the DCR were 75.00% （18/24） and 91.67% （22/24） in chemoimmunization group， and 46.88% （15/32） and 65.62% （21/32） in chemotherapy group， with statistically significant differences （χ²=4.48， P=0.034； χ²=5.21， P=0.022）. The R0 resection rate was 87.50% （21/24） in chemoimmunization group， which was higher than that of the chemotherapy group [59.38% （19/32）]， with a statistically significant difference （χ²=5.31， P=0.021）. The pCR rate and MPR rate were 29.17% （7/24） and 54.17% （13/24） in chemoimmunization group， and 6.25% （2/32） and 28.12% （9/32） in chemotherapy group， there was no statistically significant difference in pCR rate （χ²=3.78， P=0.052）， but there was a statistically significant difference in MPR rate （χ²=3.89， P=0.048）. The interval between the end of neoadjuvant treatment and the start of surgery was （42.71±8.29） days in chemoimmunization group， and （42.25±8.03） days in chemotherapy group. The intraoperative blood loss of patients was （215.54±57.85） ml in chemoimmunization group， and （229.65±57.74） ml in chemotherapy group. The operation time of patients was （293.52±37.50） minutes in chemoimmunization group， and （295.31±37.66） minutes in chemotherapy group. The postoperative hospitalization time of patients was （17.90±3.49） days in chemoimmunization group， and （18.42±3.82） days in chemotherapy group， all with no statistically significant differences （t=0.21， P=0.835； t=0.90， P=0.370； t=0.18， P=0.861； t=0.52， P=0.603）. In terms of postoperative complications， there was no statistically significant difference in the total incidence of postoperative complications between the two groups [62.50% （15/24） vs. 84.38% （27/32）， χ²=0.59， P=0.440]. The main adverse drug reactions in the two groups included decreased white blood cell count， nausea and vomiting， liver dysfunction， pruritus， hypothyroidism， etc. Most of them were grade 1-2， 3 cases were grade 3， and no grade 4 adverse reactions occurred. The total incidence of adverse reactions was 62.50% （15/24） in chemoimmunization group， and 65.62% （21/32） in chemotherapy group， with no statistically significant difference （χ²=0.06， P=0.809）. Conclusion For the preoperative neoadjuvant therapy of resectable ESCC， the combination of tislelizumab and chemotherapy has better short-term efficacy and better safety than the single chemotherapy scheme， which can improve the surgical efficacy.

Key words: Esophageal neoplasms, Immunotherapy, Tislelizumab, Neoadjuvant chemotherapy