Abstract
BACKGROUND: As neoadjuvant therapies become increasingly crucial in the management of esophageal squamous cell carcinoma (ESCC), improving local control, R0 resection rates, and overall survival, determining the optimal neoadjuvant strategy remains a priority. This study retrospectively assesses the efficacy and safety of neoadjuvant immunochemotherapy (NICT), chemoradiotherapy (NCRT), and chemotherapy (NCT) in operable ESCC. METHODS: Analyzing preoperative clinical data from resectable ESCC patients treated with NICT, NCRT, or NCT at Shandong Cancer Hospital from January 2018 to August 2022, we focused on surgical complications, pathological responses, and survival outcomes. RESULTS: Data from 300 patients (91 NICT, 113 NCRT, 96 NCT) were evaluated. The NICT group showed a lower incidence of surgical complications compared to NCRT (17.6% vs. 36.3%, p = 0.003) and was on par with NCT (17.6% vs. 22.9%, p = 0.365). NICT had less favorable complete pathological response rates than NCRT (p < 0.001) but outperformed NCT. Notably, the NICT cohort achieved superior 2-year recurrence-free (81.3%) and overall survival (93.4%) compared to NCRT (73.5% and 84.1%, p = 0.187 and p = 0.043) and NCT (44.8% and 61.5%, p < 0.001 for both). CONCLUSION: Despite a slightly lower rate of pathological remission, NICT significantly reduced surgical complications and improved survival outcomes. It presents a compelling option in the neoadjuvant treatment of resectable ESCC, with the potential to supersede NCRT and NCT.