Neoadjuvant chemoimmunotherapy versus neoadjuvant chemoradioimmunotherapy for locally advanced esophageal squamous...

Comparative evidence for neoadjuvant chemoimmunotherapy (NCIT) versus neoadjuvant immunotherapy combined with chemoradiotherapy (NICRT) in locally advanced esophageal squamous cell carcinoma (ESCC) is limited. We compared pathological response and survival outcomes between these two strategies.

We retrospectively analyzed ESCC patients who received NCIT or NICRT followed by surgery between February 2019 and March 2025 at two centers. Pathological response, 2-year overall survival (OS), and disease-free survival (DFS) were compared between groups. Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Propensity score matching (PSM) was applied to adjust for baseline imbalances.

Among 212 patients, 110 received NICRT and 102 received NCIT. After PSM, NICRT yielded higher rates of major pathological response (MPR) (77.3% vs. 41.3%; p < 0.001) and pathological complete response (pCR) rates (46.7% vs. 22.7%; p = 0.004) compared with the NCIT. Lymph node yield was significantly higher in the NCIT group than in the NICRT group. (median: 21 vs. 17; p = 0.008). Besides, the perioperative safety and recurrence patterns were comparable between groups. However, 2-year OS (82.6% vs. 87.3%) and DFS (71.4% vs.79.0%) did not differ significantly between NICRT and NCIT groups.

NICRT achieved superior pathological responses but did not improve 2-year survival compared with NCIT. Perioperative safety and recurrence patterns were similar between regimens. Prospective randomized controlled trials are needed to validate these findings.