Comparative efficacy and safety of neoadjuvant immunochemotherapy versus chemotherapy in locally advanced esophageal squamous cell carcinoma: a dual-center retrospective study

Current neoadjuvant protocols including neoadjuvant chemotherapy (NCT) demonstrate limited efficacy in controlling recurrence and metastasis for locally advanced esophageal squamous cell carcinoma (LA-ESCC). Neoadjuvant immunochemotherapy (NICT), which combines immunotherapy and chemotherapy, is emerging as a potential approach to improve treatment outcomes, although its comparative efficacy to NCT remains underexplored. This study aims to assess the efficacy and safety of NICT compared to NCT in patients with LA-ESCC. This dual-center, retrospective study included 276 patients diagnosed with LA-ESCC between 2017 and 2022. Participants were divided into NICT and NCT cohorts. Propensity score matching (PSM) based on all baseline characteristics of the two cohorts was performed. Comparative analyses were performed on pathological outcomes, perioperative complications, and survival outcomes. Logistic regression and Cox proportional hazards models were used to identify factors influencing pathological complete response (pCR) and disease-free survival (DFS). After PSM, 91 patients in the NICT group and 120 patients in the NCT group were included for subsequent analysis. The study found that NICT resulted in significantly higher rates of pCR (27.47% vs. 13.33%, p < 0.001) and MPR (52.75% vs. 35.83%, p < 0.001) compared to NCT. DFS was also significantly improved in the NICT group (p = 0.005). Moreover, the incidence of respiratory complications was lower in the NICT group (68.13% vs. 80.00%, p = 0.049). NICT demonstrated superior efficacy over NCT in improving pathological responses and survival outcomes, while also reducing perioperative complications. These findings suggest NICT could be a promising treatment option for LA-ESCC.