Comparison Of The Efficiacy And Safety Of Preoperative Neoadjuvant Chemotherapy Combined With Sintilimab And Neoadjuvant Chemotherapy Alone In The Treatment Of Locally Advanced Esophageal Squamous Cell Carcinoma

Objective:To compare the efficiacy and adverse reactions of preoperative neoadjuvant chemotherapy combined with sintilimab and neoadjuvant chemotherapy alone in the treatment of locally advanced esophageal squamous cell carcinoma,and to provide a basis for the formlation of preoperative neoadjuvant therapy for resectable locally advanced esophageal squamous cell carcinoma.Methods:A retrospective analysis was made on 97 patients with esophageal squamous cell carcinoma treated in the Department of Thoracic surgery of the Affiliated Hosipital of North Sichuan Medical College from December 2019 to January 2022,including 40 cases of neoadjuvant chemotherapy(nedaplatin+docetaxel)combined with immunotherapy(neoadjuvant chemotherapy combined with immunotherapy,nICT)and 57 cases of preoperative neoadjuvant chemotherapy((nedaplatin+docetaxel)(neoadjuvant chemotherapy,nCT).The safety and short-term efficacy were campared.Result:1.The mian adverse reactions during neoadjuvant therapy in the nICT group and nCT group were nausea(45.0%vs 49.1%)and anorexia(42.5%vs 50.9%),among those adverse reactions the incidences of leukopenia(30.0%vs 33.3%),neutropenia(25.0%vs 22.8%)andanemia(27.5%vs 29.8%)were not statistically significant(P>0.05).However the incidences of elevated transminase and hypothyroidism were higher than that in nCT group(27.5%vs 15.8%,10.0%vs 0.0%),the difference was statisitically significant(P<0.05).Meanwhile the incidence of grade 3 and above adverse events was(12.5%vs 10.5%),with no statisitically significant difference(P>0.05).2.The pathological complete response(pCR)rate of patients in nICT group after neoadjuvant therapy was significantly higher than that in nCT group(25.0%vs 7.0%,P=0.027).And the objective response rate(ORR)in nICT group was also higher than that in nCT group(62.5%vs 52.6%,P=0.041),While the disease control rate(DOR)was lower than that in nCT group(87.5%vs 93.0%,P=0.654),with no statisitically significant difference.Moreover the R0 rescection rate in nICT group was slightly lower than that in nCT group(90.0%vs 94.7%),but the difference was not statisitically significant.3.In the nICT group 31 patients underwent Mekeowm procedure(31/40,77.5%)and 9 petients were converted to Sweet procedure(9/40,22.5%).Thus the proportion of thoracotomy in the nICT group was higher than that in nCT group(12.3%),but the difference was not statisitically significant.4.The most common postoperative complications in nICT and nCT group were pneumonia(47.5%vs 36.7%),followed by atrial fibrillation(15.8%vs 12.3%),deep venous thrombosis(DVT)(7.5%vs 8.8%),anastomotic leakage(5.0%vs 7.0%),recurrent laryngeal nerve paralysis(5.0%vs 5.3%),chylothorax(2.5%vs 3.5%)etc,those differences were not statisitically significant(P>0.05).5.In nICT group,postoperative recurrence occurred in 7cases,including regional recurrence in 5 caseand distant metastasis in 2 cases.While in nCT group,postoperative recurrence occurred in 14 cases,including regional recurrence in 10 cases and distant metastasis in 4 cases.The common type of recurrence in two groups was regional recurrence,and there was no significant difference in the location of recurrence(P>0.05).After log-rank test,patients in nICT group had a tendency to benefit from disease progression-free survival time(PFS)compared with patients in nCT group(HR=0.36,95%CI=0.14-0.92,P=0.031).Conclusion:Preoperative neoadjuvant chemotheraoy combined with sitilimab is safe and feasible than neoadjuvant chemotherapy alone in the treatment of locally advanced esophageal squamous cell carcinoma,otherwise the pathological complete remission rate and objective remission rate are higher than that,and do not increase the risk of surgical complications.