Abstract
OBJECTIVES: Neoadjuvant chemoradiotherapy (NCRT) remains the standard for locally advanced oesophageal squamous cell carcinoma. Emerging evidence on neoadjuvant immunochemotherapy (NICT) has shown promising short-term efficacy, although it is associated with lower pathological complete response rates. The retrospective study aims to compare recurrence patterns and survival outcomes of satisfactory tumour response (ypStage I/ypT0-2N0M0) after either modality followed by surgery. METHODS: We analysed ypStage I patients who underwent McKeown oesophagectomy at Sun Yat-sen University Cancer Center (July 2009-July 2022). Propensity score matching (1:1) balanced baseline characteristics. Overall survival (OS), disease-free survival (DFS), and recurrence patterns were analysed. RESULTS: Totally, 156 cases of NCRT, 63 cases of NICT were included. After matching (63 pairs), recurrence patterns diverged significantly: the NICT group had predominant regional lymph node recurrence (100% vs 22.73%, P < .001), larger recurrent lesions (median 41 vs 24 mm, P = .011), and lower distant metastasis (42.86% vs 86.36%, P = .021). It also showed superior 3-year OS (90.07% vs 83.44%, P = .021), 3-year DFS (88.89% vs 76.03%, P = .011), and better conditional survival beyond 2 years (P = .032, P = .008). CONCLUSIONS: Recurrence patterns differ between the two modalities in ypStage I patients. NICT was associated with better survival. Studies comparing the two modalities should focus more on survival rather than tumour response in oesophageal squamous cell cancer.