Treatment patterns and clinical outcomes of neoadjuvant chemoimmunotherapy for patients with resected oesophageal squamous cell carcinoma: a Chinese multicentre retrospective study

Background: Several clinical trials of neoadjuvant chemoimmunotherapy (neoCIT) for patients with locally advanced oesophageal carcinoma have been reported recently, with promising anti-tumour efficacy. However, systematic evaluation of the treatment patterns and clinical outcomes in a real-world cohort is lacking. Objectives: This study aimed to describe the real-world treatment patterns and short- and long-term outcomes of neoCIT in patients with resected oesophageal squamous cell carcinoma (ESCC). Design: A multicentre retrospective cohort study. Methods: Data from patients with resected ESCC who received neoCIT in routine clinical practice between January 2020 and December 2022 were retrospectively collected from three tertiary centres in China. Results: A total of 324 consecutive patients were enrolled, and the majority (82.4%) received two cycles of neoCIT. In total, 225 patients achieved a radiographic partial response (PR), resulting in an objective response rate of 69.4%. The rates of minimally invasive oesophagectomy and radical resection were 71.9% and 98.5%, respectively. Fifty-nine patients (18.2%) experienced postoperative complications, and the most common complication was anastomotic leakage (10.2%). The pathological complete response and major pathological response rates were 27.2% and 37.0%, respectively. As of August 31, 2024, the median follow-up was 24.8 months. The estimated 3-year rates of disease-free survival and overall survival were 62.3% and 71.5%, respectively. Multivariate analyses revealed that tumour grade ( p = 0.047), number of neoadjuvant therapy cycles ( p = 0.042), resection status ( p = 0.043), pathological N stage ( p < 0.001) and adjuvant treatment ( p < 0.001) were independent prognostic factors for disease-free survival. However, advanced pathological N stage was identified as the sole independent factor that correlated with worse overall survival ( p < 0.001). Conclusion: This real-world study validates the clinical efficacy and safety of neoCIT for resected oesophageal squamous cell carcinoma while demonstrating encouraging survival outcomes.