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A Comparison of Clinicopathologic Outcomes and Patterns of Lymphatic Spread Across Neoadjuvant Chemotherapy, Neoadjuvant Chemoradiotherapy, and Neoadjuvant Immunochemotherapy in Locally Advanced Esophageal Squamous Cell Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemoradiotherapy (NCRT) is recommended as the treatment standard for locally advanced esophageal squamous cell carcinoma (ESCC). The use of immunotherapy in the neoadjuvant setting has gained attention. Multiple, clinical trials have explored the efficacy and safety of neoadjuvant immunochemotherapy (NICT). We evaluated the differences in clinicopathologic outcomes and the patterns of lymphatic spread among patients receiving neoadjuvant chemotherapy (NCT), NCRT, and NICT before esophagectomy for locally advanced ESCC.

Methods

A total of 702 patients with ESCC who completed transthoracic esophagectomy followed neoadjuvant therapy were included. Pathological characteristics, including pathologic complete response (pCR), tumor regression grade (TRG) score and patterns of lymphatic spread, were evaluated.

Results

Compared with the NCT group, the NCRT group and NICT group had an advantage in pathological response (P < 0.05). The pCR rate was 8.1% in the NCT group, 29.9% in the NCRT group, and 23.6% in the NICT group. The TRG score (P < 0.05) and pathologic T stage (P < 0.05) in the NCT group were significantly higher. Compared with NICT, NCRT can significantly reduce the rate of lymph node metastasis rate in station 1R (0 vs. 3.4%, P < 0.05) and 2R (1.1% vs. 6.8%, P < 0.05). Subgroup analysis according to the tumor location distribution showed that NICT group had higher lymph node metastasis rate in station 2R (9.1%) in middle thoracic cases (P < 0.05) and in station 18 (7.5%) (P < 0.05) in lower thoracic cases.

Conclusions

NCRT or NICT followed by surgery may result in a promising pCR rate and show a better performance in therapeutic response of primary lesion. For patients with lymph node metastasis in station 1R and 2R, NCRT should be the optimal preoperative treatment strategy.

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Data availability

All data generated and analyzed during this study are included in this published article (and its supplementary information files).

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Acknowledgments

We thank thoracic surgeon (Prof. Ganjun Kang), pathologist (Prof. Jingping Yuan), and radiologist (Prof. Jun Chen) for their suggestions to the revised manuscript.

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Author notes

  1. Yuanyuan Tian, Zhenguo Shi and Chenyu Wang have contributed equally to this work.

Authors and Affiliations

  1. Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China

    Yuanyuan Tian MD, Zhenguo Shi MD, Shaobo Ke MD, Hu Qiu MD, Wensi Zhao MD, Yong Wu MD, Jiamei Chen MD & Yongshun Chen MD

  2. Department of Oncology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China

    Zhenguo Shi MD

  3. Department of Thoracic Oncology, Anyang Tumor Hospital, Henan Medical key Laboratory of Precise Prevention and Treatment of Esophageal Cancer, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Anyang, China

    Chenyu Wang MD & Yaowen Zhang MD

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Tian, Y., Shi, Z., Wang, C. et al. A Comparison of Clinicopathologic Outcomes and Patterns of Lymphatic Spread Across Neoadjuvant Chemotherapy, Neoadjuvant Chemoradiotherapy, and Neoadjuvant Immunochemotherapy in Locally Advanced Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 31, 860–871 (2024). https://doi.org/10.1245/s10434-023-14534-9

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