Immunochemotherapy Versus Chemoradiotherapy Followed by Conversion Surgery for Initially Unresectable Stage cT4...

Chemoradiotherapy has proven effective in enabling conversion surgery (CS). However, the priority of immunochemotherapy compared with chemoradiotherapy as induction therapy for initially unresectable cT4 esophageal squamous cell carcinoma (ESCC) remains unclear. We aimed to compare the survival outcomes of CS following induction immunochemotherapy (iICT) versus induction chemoradiotherapy (iCRT) in these patients.

This multi-institutional retrospective cohort study included initially unresectable cT4 ESCC patients who underwent CS after iICT or iCRT between 2019 and 2022. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and the log-rank-test. Univariable and multivariable analyses for prognostic factors were performed.

In total, 118 patients were included: 43 in the iICT group and 75 in the iCRT group. There were no significant differences between the two groups in terms of pathological complete response rates (P = 0.637) or R0 resection rates (P = 0.885). The iICT group had a lower rate of postoperative overall recurrence (P = 0.005) and distant metastasis (P = 0.015) than the iCRT group. The OS (1-year: 90.4% vs. 76.0%; 3-year: 77.3% vs. 54.9%, P = 0.027) and DFS (1-year: 85.4% vs. 58.7%; 3-year: 73.1% vs. 39.0%, P = 0.001) rates were significantly higher in the iICT group than in the iCRT group. Multivariable Cox analysis demonstrated that the iICT regimen was independently associated with improved OS and DFS.

iICT combined with CS was a safe and manageable treatment option and was associated with improved OS and DFS in patients with initially unresectable cT4 ESCC.