Clinical Outcomes Of Neoadjuvant Immunotherapy Combined With Chemotherapy In The Treatment Of Locally Advanced Resectable Squamous Oesophageal Cancer

Object:To investigate the effectiveness and safety of neoadjuvant immunotherapy combined with chemotherapy in the treatment of locally advanced resectable esophageal squamous carcinoma,with a view to providing an evidence-based basis for the future clinical management of locally advanced esophageal carcinoma.Method:A retrospective analysis of the clinical data of 45 patients with stage II-IVA esophageal pathological squamous carcinoma who underwent surgery after 2 cycles of neoadjuvant immune combination chemotherapy at the Department of Thoracic Surgery,Second Affiliated Hospital of Nanchang University between January 2019 and January 2022.A total of 38 patients met the inclusion and exclusion criteria and were set up as the observation group(neoadjuvant group);and 286 patients who attended the same time period from the 38 patients were selected as the control group(surgery alone group)based on a 1:1 propensity.The efficacy of neoadjuvant immunochemotherapy was assessed in the neoadjuvant group according to RECIST1.1 criteria;adverse events were recorded according to CTCAE 5.0.and the surgery-only group was compared in terms of operative time,intraoperative bleeding,intraoperative blood transfusion,number of resected and metastatic lymph nodes,postoperative complications,DFS and other parameters.Result:On comparison,the surgery-only group was less likely to have intraoperative blood transfusions than the neoadjuvant group(p=0),while the neoadjuvant group had fewer lymph node metastases than the surgery-only group(p=0.038).The incidence of postoperative complications was similar in both groups and was not statistically significant.Clinical data from 38 patients in the neoadjuvant group were analysed according to the WHO Criteria for Evaluation of the Efficacy of Solid Tumours(RECIST 1.1)and revealed 8(21.1%)CRs,11(28.9%)PRs,17(44.7%)SDs and 2(5.3%)PDs;ORR(objective remission rate)was 50% and DCR(disease control rate)was 94.7%.In the neoadjuvant group,four patients(10.5%)achieved p CR,14 patients(36.8%)achieved MPR(including one yp T0N1M0 and three yp Tis N0M0)and 20 patients(52.6%)achieved IPR.17 patients(44.7%)experienced c T reduction after 2 cycles of neoadjuvant therapy;13 of these patients(34.2%)experienced c T reduction.The c N-declining phase was observed in 13(34.2%)patients.All adverse events during neoadjuvant treatment were ≤ grade 3.After a median follow-up of 16.25 months,six patients(15.8%)in the neoadjuvant group and14 patients(36.8%)in the surgery-only group developed recurrence or metastasis.While N stage was calculated by Fisher’s exact test as an influencing factor for pathological remission(p CR+MPR)(p=0.009);a higher risk of recurrence/metastasis was found in patients in the surgery-only group compared to the neoadjuvant group by chi-square test(p=0.037).Conclusion:1.Neoadjuvant immune combination chemotherapy for locally advanced esophageal squamous cell carcinoma can achieve better clinical downstaging and pathological response with controlled drug toxicity and no increased perioperative complications,thus making it an effective and safe treatment for locally advanced resectable esophageal squamous cell carcinoma.2.Neoadjuvant immunotherapy combined with chemotherapy significantly improves DFS in patients with locally advanced squamous oesophageal cancer compared with surgery.