Abstract
BACKGROUND: Current understanding of neoadjuvant immunochemotherapy for locally advanced esophageal squamous cell carcinoma (ESCC) lacks high-level evidence. This study provides additional efficacy data for this treatment regimen. METHODS: Clinical trials investigating neoadjuvant tislelizumab plus chemotherapy in locally advanced ESCC were identified through literature search. Raw data from investigators were pooled for analysis. Primary endpoint was pCR; secondary endpoints included MPR, R0 resection rate, EFS, DFS, and OS. RESULTS: Six studies involving 306 patients were analyzed; 275 (89.9%) underwent surgery. Among surgical patients, pCR rate was 25.5% and MPR rate was 49.5%. Most patients (98.5%) achieved R0 resection. At median follow-up of 31.3 months, median EFS, DFS, and OS were not reached. The 1-/2-/3-year rates were: EFS 81.8%/66.9%/59.1%; DFS 79.0%/68.7%/62.3%; and OS 91.7%/77.5%/73.4%. Tislelizumab dose intensity correlated with MPR. MPR and R0 resection were independent prognostic factors for EFS and OS, while pathological staging was associated with DFS and OS. CONCLUSIONS: Neoadjuvant tislelizumab combined with chemotherapy demonstrated promising efficacy with encouraging pathological responses and survival outcomes in locally advanced ESCC, supporting clinical application.