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Preoperative chemoimmunotherapy vs chemoradiotherapy in cT4 ESCC: a multicenter retrospective study
Kanghua Zhang1, Chang Yuan2, Xiaofang Chen3
1State Key Laboratory of Metabolic Dysregulation & Prevention and Treatment of Esophageal Cancer, Zhengzhou, Henan Province, 450052, China; Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052, China.
Preoperative chemoimmunotherapy (pre-CIT) improved overall survival and disease-free survival in patients with clinical T4 esophageal squamous cell carcinoma (ESCC) compared to preoperative chemoradiotherapy (pre-CRT). Further research is needed to confirm these findings.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Clinical T4 esophageal squamous cell carcinoma (ESCC) presents significant treatment challenges.
- Evidence for optimal preoperative strategies in surgical candidates with cT4 ESCC is limited.
Purpose of the Study:
- To compare the efficacy of preoperative chemoimmunotherapy (pre-CIT) versus preoperative chemoradiotherapy (pre-CRT) in patients with cT4 ESCC undergoing esophagectomy.
- To evaluate overall survival (OS), disease-free survival (DFS), and recurrence patterns.
Main Methods:
- Retrospective analysis of 235 patients with cT4 ESCC from three Chinese centers.
- Comparison between pre-CIT (n=124) and pre-CRT (n=111) groups, with propensity score matching applied.
- Analysis included overall survival, disease-free survival, postoperative complications, and recurrence rates.
Main Results:
- Two-year OS and DFS were significantly higher in the pre-CIT group (76.4% vs 55.2% and 73.6% vs 51.6%, respectively).
- Pre-CRT was associated with worse OS and DFS in multivariable models (HR 1.80 and 2.01).
- Distant metastasis occurred less frequently with pre-CIT (11.3% vs 20.7%), while locoregional recurrence did not differ significantly.
Conclusions:
- Preoperative chemoimmunotherapy is associated with improved survival outcomes in surgical cT4 ESCC patients.
- Postoperative complications and locoregional recurrence rates were comparable between the two treatment groups.
- Prospective studies are warranted to validate these findings.