Discover oncology · 2025
A meta-analysis based on propensity analysis studies comparing neoadjuvant immunochemotherapy and neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma.
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Jin Zixian, Zhu Jiani, Zhang Jian, Shen Jianfei, Zhang Bo
Аннотация
BACKGROUND: To systematically compare the efficacy and safety of neoadjuvant immunochemotherapy (NICT) and neoadjuvant chemoradiotherapy (NCRT) in the treatment of resectable esophageal squamous cell carcinoma (ESCC).
METHODS: Databases were searched to collect clinical studies comparing NICT and NCRT for ESCC based on propensity score analysis. Primary outcomes included overall survival (OS), disease-free survival (DFS), pathological response rate, local recurrence and distant relapse rate. Secondary outcomes included the number of lymph nodes dissected, R0 resection rate, and postoperative complication rates.
RESULTS: 11 studies involving 4,684 patients were included. The NICT group showed significantly better OS and DFS than the NCRT group (HR = 0.61, 95% CI: 0.52-0.72; HR = 0.62, 95% CI: 0.53-0.72). The pathological complete response (pCR) rate and major pathological response (MPR) rate were lower in the NICT group (RR = 0.67, 95% CI: 0.56-0.81; RR = 0.75, 95% CI: 0.65-0.86). However, there was no significant difference in the local recurrence rate between NICT and NCRT group (RR = 0.93, 95%CI 0.51-1.72, I2 = 58%), and NICT group had a greater advantage in the distant relapse rate (RR = 0.51, 95%CI 0.40-0.65, I2 = 0). The number of lymph nodes dissected was significantly higher in the NICT group (MD = 6.68, 95% CI: 4.00-9.36). No significant differences were observed in R0 resection rate or major postoperative complication rates between the two groups.
CONCLUSIONS: NICT demonstrated superior survival benefits compared to NCRT in the treatment of ESCC, despite its lower pCR and MPR rate. The safety of the two treatment methods were comparable.
METHODS: Databases were searched to collect clinical studies comparing NICT and NCRT for ESCC based on propensity score analysis. Primary outcomes included overall survival (OS), disease-free survival (DFS), pathological response rate, local recurrence and distant relapse rate. Secondary outcomes included the number of lymph nodes dissected, R0 resection rate, and postoperative complication rates.
RESULTS: 11 studies involving 4,684 patients were included. The NICT group showed significantly better OS and DFS than the NCRT group (HR = 0.61, 95% CI: 0.52-0.72; HR = 0.62, 95% CI: 0.53-0.72). The pathological complete response (pCR) rate and major pathological response (MPR) rate were lower in the NICT group (RR = 0.67, 95% CI: 0.56-0.81; RR = 0.75, 95% CI: 0.65-0.86). However, there was no significant difference in the local recurrence rate between NICT and NCRT group (RR = 0.93, 95%CI 0.51-1.72, I2 = 58%), and NICT group had a greater advantage in the distant relapse rate (RR = 0.51, 95%CI 0.40-0.65, I2 = 0). The number of lymph nodes dissected was significantly higher in the NICT group (MD = 6.68, 95% CI: 4.00-9.36). No significant differences were observed in R0 resection rate or major postoperative complication rates between the two groups.
CONCLUSIONS: NICT demonstrated superior survival benefits compared to NCRT in the treatment of ESCC, despite its lower pCR and MPR rate. The safety of the two treatment methods were comparable.