Conversion Surgery Following Immunochemotherapy in Initially Unresectable Locally Advanced Esophageal Squamous Cell...

Area of Science:

• Oncology
• Surgical Oncology
• Immunotherapy

Background:

• Locally advanced esophageal squamous cell carcinoma (ESCC) that is initially unresectable poses a significant treatment challenge.
• Neoadjuvant chemotherapy has been a standard approach, but outcomes remain suboptimal for many patients.
• The integration of immunotherapy into neoadjuvant regimens offers a potential strategy to improve resectability and survival.

Purpose of the Study:

• To evaluate the real-world feasibility, safety, and effectiveness of conversion surgery after induction immunochemotherapy (PD-1 inhibitor plus chemotherapy) for unresectable locally advanced ESCC.
• To compare the outcomes of induction immunochemotherapy followed by conversion surgery with those of traditional induction chemotherapy.
• To assess radiological and pathological tumor responses, as well as short-term survival in this patient population.

Main Methods:

• A multi-center, real-world study involving patients with unresectable ESCC who received at least two cycles of PD-1 inhibitor plus chemotherapy.
• Patients with significant clinical symptom relief and radiological response were considered candidates for conversion surgery (esophagectomy).
• Outcomes were compared with an independent cohort receiving induction chemotherapy (iC).

Main Results:

• A conversion surgery rate of 74.8% was achieved in 116 patients, with an R0 resection rate of 94%.
• Induction immunochemotherapy (iIC) demonstrated significantly higher objective response rates (63.2% vs. 47.7%) and pathological complete response rates (22.4% vs. 6.7%) compared to iC.
• The iIC group had a lower anastomosis fistula rate (4% vs. 19.2%) and significantly higher event-free survival after conversion surgery.

Conclusions:

• Conversion surgery following induction immunochemotherapy is a feasible and safe treatment strategy for patients with initially unresectable locally advanced ESCC.
• Induction immunochemotherapy leads to superior radiological and pathological response rates compared to traditional induction chemotherapy.
• This combined approach holds promise for improving outcomes in patients with advanced ESCC.