Efficacy And Safety Of Neoadjuvant Chemotherapy Combined With Immunotherapy In Locally Advanced Esophageal Squamous Cell Carcinoma

Objective:The effect of Neoadjuvant chemotherapy combined with immunotherapy on Esophageal squamous cell carcinoma in local advanced(II-IVA).Methods:From June 2020 to August 2021,the clinical data of patients with ESCC who underwent neoadjuvant immunotherapy and chemotherapy in the Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were retrospectively analyzed.The efficacy of the regimen was evaluated according to RECIST 1.1 and tumor regression classification criteria.Adverse events were recorded according to CTCAE 4.0 criteria.Kaplan-Meier method was used to calculate disease-free survival.Univariate and multivariate analysis were used to analyze the factors affecting the main pathological remission rate major pathologic response.Results:A total of 46 patients were enrolled,including 12 cases(26.1 %)of clinical stage II,28 cases(60.9 %)of clinical stage III and 6 cases(13.0 %)of clinical stage IVa at baseline.43 patients completed two cycles of neoadjuvant therapy,of which 3 patients were lost to follow-up after only one cycle of neoadjuvant therapy,3patients were lost to follow-up after two cycles of neoadjuvant therapy,8 patients did not receive surgical treatment,and 4 patients abandoned treatment due to disease progression.32 patients completed the operation,27 cases(84.4 %)completed minimally invasive esophagectomy,31 cases(96.8 %)completed R0 resection,7cases(21.9 %)were found by postoperative pathology complete pathological remission rate,15 cases(46.8 %)MPR.According to RECIST 1.1,the objective remission rate of 32 patients undergoing surgery was 43.8 %,14 patients(43.8 %)decreased in T stage and N stage,and 16 patients(53.3 %)decreased in N stage among 30 patients with potential lymph node metastasis.During neoadjuvant therapy and follow-up,29 cases(63.1 %)had treatment-related AE,but only 11 cases(23.9 %)had grade ≥ 3 treatment-related AE,of which 1 case(2.1 %)died;the common adverse reactions were leukopenia(56.5 %),followed by fatigue(52.2 %)and neutrophils(43.5 %).The median follow-up time was 13.67 months(IQR : 7.4– 17.6).Five patients(15.6 %)had recurrence or metastasis 4 – 12 months after surgery.Patients in the Non-MPR group had higher risk of tumor recurrence or metastasis than those in the MPR group(P = 0.031).There was no significant difference between the two groups in age,gender,BMI,smoking history,drinking history,tumor location,drug selection,tumor clinical stage,and the interval from neoadjuvant completion to surgery.Conclusions:Neoadjuvant immunotherapy combined with chemotherapy for locally advanced thoracic esophageal squamous cell carcinoma is safe,feasible and effective,which is worthy of further study.The disease-free survival time of MRP group was significantly longer than that of Non-MPR group,which was one of the factors predicting the prognosis of patients.There was no significant difference between the two groups in age,gender,BMI,smoking history,drinking history,tumor location,drug selection,tumor clinical stage,and the interval from neoadjuvant completion to surgery.