Induction Therapies for Locally Advanced Marginally Resectable and Unresectable Escc and Conversion Surgery Prognosis: A Real-World Study

Background The prognosis of locally advanced borderline resectable esophageal squamous cell carcinoma (BR-ESCC) and unresectable esophageal squamous cell carcinoma (UR-ESCC) is poor. Induction therapy makes it possible for downstaging of tumor to have a opportunity of radical resection, thus improving the prognosis. However, the optimal induction therapy remains under exploration, and the prognostic value of conversion surgery remains controversial. Methods This was a retrospective study of patients with BR-ESCC and UR-ESCC who received chemotherapy (group CT), chemoradiotherapy (group CRT) and immunochemotherapy (group ICT) as the initial induction therapy. Based on induction therapy effect, patients received treatment with surgery (group ST), non-surgical treatment (group NST) and non-treatment (group NT). The outcomes included initial imaging efficacy, adverse events (AEs) of initial induction therapy and overall survival (OS). Results The objective response rate (ORR) of the primary tumor lesions, ORR of the lymph nodes with a maximum short axis > 1.0 cm, tumor downstaging rate and the potential R0 resection rate after initial induction therapy were 49.7%, 36.4%, 40.0% and 54.1%, respectively. ICT group showed significantly higher lymph node ORR vs. CT/CRT (P = 0.015), with numerically higher primary tumor ORR and downstaging (P > 0.05). Grade 3+ AE rates were comparable across groups (P > 0.05). Post-induction potential R0-resectable ESCC patients in ST group had superior OS vs. NST (P = 0.007); no OS difference in others (P = 0.271). Conclusion ICT is superior to CT and CRT in terms of induction efficacy and the three exhibit similar incidence rates of adverse reactions. Treatment modalities involving conversion surgery are recommended in patients with potential R0 resectable ESCC after induction therapy. Non-surgical treatment is still a better option for the others.