Abstract
AIM: To assess the efficacy of immune checkpoint inhibitors (ICIs) combined with chemoradiotherapy and evaluate the prognostic value of peripheral inflammatory markers in elderly patients with inoperable esophageal squamous cell carcinoma (ESCC). METHODS: A retrospective study of 124 elderly ESCC patients treated between 2021 and 2024. Patients were divided into immunotherapy and non-immunotherapy groups. Progression-free survival (PFS) was compared, and inflammatory markers were analyzed using Cox regression and ROC curves. RESULTS: Median PFS was significantly longer in the ICI group (13.7 vs. 10.9 months, P = 0.043). Immunotherapy was an independent protective factor for PFS. Post-treatment NLR and PNI were predictive of outcomes in the ICI group. CONCLUSION: Combining ICIs with chemoradiotherapy improves survival in elderly inoperable ESCC patients. NLR and PNI may serve as accessible biomarkers to guide immunotherapy.