A meta-analysis based on propensity analysis studies comparing neoadjuvant immunochemotherapy and neoadjuvant...

To systematically compare the efficacy and safety of neoadjuvant immunochemotherapy (NICT) and neoadjuvant chemoradiotherapy (NCRT) in the treatment of resectable esophageal squamous cell carcinoma (ESCC).

Databases were searched to collect clinical studies comparing NICT and NCRT for ESCC based on propensity score analysis. Primary outcomes included overall survival (OS), disease-free survival (DFS), pathological response rate, local recurrence and distant relapse rate. Secondary outcomes included the number of lymph nodes dissected, R0 resection rate, and postoperative complication rates.

11 studies involving 4,684 patients were included. The NICT group showed significantly better OS and DFS than the NCRT group (HR = 0.61, 95% CI: 0.52-0.72; HR = 0.62, 95% CI: 0.53-0.72). The pathological complete response (pCR) rate and major pathological response (MPR) rate were lower in the NICT group (RR = 0.67, 95% CI: 0.56-0.81; RR = 0.75, 95% CI: 0.65-0.86). However, there was no significant difference in the local recurrence rate between NICT and NCRT group (RR = 0.93, 95%CI 0.51-1.72, I² = 58%), and NICT group had a greater advantage in the distant relapse rate (RR = 0.51, 95%CI 0.40-0.65, I² = 0). The number of lymph nodes dissected was significantly higher in the NICT group (MD = 6.68, 95% CI: 4.00-9.36). No significant differences were observed in R0 resection rate or major postoperative complication rates between the two groups.

NICT demonstrated superior survival benefits compared to NCRT in the treatment of ESCC, despite its lower pCR and MPR rate. The safety of the two treatment methods were comparable.