Timing of surgery after neoadjuvant chemoimmunotherapy impacts survival in operable esophageal squamous cell carcinoma
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Key Takeaway
Note that surgery within 6 weeks of neoadjuvant therapy is associated with longer overall survival in ESCC.
This multicenter retrospective cohort study included 163 patients with operable esophageal squamous cell carcinoma (ESCC) who received neoadjuvant chemoimmunotherapy (NICT). The study assessed the impact of the interval between NICT completion and subsequent surgery on clinical outcomes, including overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS). Other independent influencing factors included tumor location, number of NICT cycles, and tumor volume change rate.
Regarding the primary outcome of overall survival, the analysis found that surgery performed within six weeks of neoadjuvant therapy was significantly associated with longer OS. For disease-free and progression-free survival, results indicated a trend toward improvement with surgery performed within this six-week window, though statistical significance was not explicitly reported for these specific outcomes. Additional independent factors influencing DFS and PFS included tumor location, the number of NICT cycles administered, and the tumor volume change rate.
Safety and tolerability data, including adverse events, serious adverse events, discontinuations, and general tolerability, were not reported in the study. The study design was retrospective, and the publication type was a multicenter study, but the specific phase of development was not reported. No specific limitations were listed in the provided data, nor were funding sources or conflicts of interest disclosed. Consequently, the evidence regarding the timing of surgery is observational and does not establish causality. Clinicians should interpret these findings with caution, noting the absence of safety reporting and the inherent limitations of retrospective analysis.
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View Original Abstract ↓
PurposeIn recent years, neoadjuvant chemoimmunotherapy (NICT) has become a research focus in the treatment of esophageal cancer. This study aims to evaluate the predictive value of tumor volume changes before and after NICT for prognosis in patients with operable esophageal squamous cell carcinoma (ESCC).Materials and methodsThis retrospective study included 163 patients with histologically confirmed ESCC from two medical centers between October 1, 2020, and October 1, 2022. All patients received NICT before undergoing radical esophagectomy. Based on pre- and post−treatment CT images, we delineated and calculated the volume of the esophageal tumor. The rate of tumor volume change was then analyzed for its association with patient prognosis. The study endpoints were overall survival (OS), disease−free survival (DFS) and progression−free survival (PFS).ResultsMultivariate regression analysis indicated that tumor location, number of NICT cycles, and tumor volume change rate were independent influencing factors for both DFS and PFS. The interval between NICT completion and surgery, along with tumor volume change rate, were independent factors for OS. Significant tumor volume reduction served as a predictor of favorable prognosis, demonstrating certain predictive value for long-term survival in patients. Surgery performed within 6 weeks of neoadjuvant therapy was significantly associated with longer OS, while DFS and PFS also showed a trend toward improvement.ConclusionThe change in tumor volume before and after neoadjuvant therapy is an independent prognostic factor for esophageal cancer patients receiving NICT. Additionally, performing radical surgery as soon as possible after completing neoadjuvant therapy is associated with improved survival outcomes.
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