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Published on: April 22, 2019
Neoadjuvant Immuno-Chemotherapy Versus Neoadjuvant Chemoradiotherapy in Locally Advanced Oesophageal Squamous Cell
Yuxin Yang1, Chang Yuan1, Bin Li1
1Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
Objectives:
The chemoradiotherapy for oesophageal cancer followed by surgery study (CROSS) regimen has been the standard neoadjuvant treatment for oesophageal squamous cell carcinoma over the last decade. However, the emerging Neoadjuvant Immuno-Chemotherapy followed by Esophagectomy (NICE) regimen has shown promising potential. This study compares the treatment response and the long-term outcomes of NICE versus CROSS for oesophageal squamous cell carcinoma.
Methods:
We retrospectively analysed patients who underwent the NICE or the CROSS regimen between January 2018 and April 2022. NICE comprised camrelizumab with carboplatin and paclitaxel over two 21-day cycles. CROSS included carboplatin and paclitaxel chemotherapy with concurrent radiotherapy (41.4 Gy) per protocol. After matching, 177 patients were included in each group for analysis.
Results:
The pathological complete remission (pCR) rates were similar between the NICE and the CROSS (20.9% vs 25.4%, P = .314) regimens. NICE demonstrated superior 3-year overall survival (73.5% vs 58.4%, P = .003) and cancer-specific survival (77.3% vs 64.3%, P = .006). Recurrence rates, including local and distant recurrences, were comparable. Subgroup analysis revealed no survival differences in patients with a pCR (hazard ratio 1.65, 95% CI 0.56-4.84), but patients without non-pCR in the NICE group showed improved overall survival compared to those in the CROSS (hazard ratio 1.86, 95% CI 1.24-2.77) group. Patients following NICE reported higher proportions of adjuvant therapy than those following CROSS (P < .001) and were largely driven by immunotherapy (OR 5.45). Furthermore, in multivariable analysis, receipt of adjuvant therapy was identified as a significant promoter for improving long-term prognosis after NICE.
Conclusions:
NICE offers better survival than CROSS with similar recurrence patterns. Adjuvant immunotherapy might be an important factor for long-term benefits in residual pathological disease after NICE.
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