The Role of Adjuvant Therapy in Non-pCR Patients After Neoadjuvant Chemoimmunotherapy: Comparison With Neoadjuvant Chemoradiotherapy for ESCC
Menée à l'aide de données portant sur 458 patients atteints d'un carcinome épidermoïde de l'oesophage, cette étude analyse l'efficacité, du point de vue de la survie globale et de la survie sans maladie à 2 ans, de 2 traitements préopératoires (chimioimmunothérapie ou radiochimiothérapie) puis évalue l'intérêt d'un traitement postopératoire chez les patients n'ayant pas obtenu de réponse complète lors du traitement préopératoire
Background: Neoadjuvant chemoimmunotherapy (NCIT) is increasingly used for locally advanced esophageal squamous cell carcinoma (ESCC), but the role of adjuvant therapy—particularly immunotherapy—after NCIT remains undefined.
Methods: This single-institution retrospective study included 458 ESCC patients treated with neoadjuvant chemoradiotherapy (NCRT, n=187) or NCIT (n=271) followed by esophagectomy (2021–2024). A 1:1 propensity score matching (PSM) based exclusively on pretreatment characteristics was used to compare the neoadjuvant strategies. To assess postoperative adjuvant therapy while addressing guarantee-time bias and subgroup imbalance, a 60-day landmark analysis with separate propensity-score overlap weighting within NCRT and NCIT was performed. Primary endpoints were 2-year overall survival (OS) and disease-free survival (DFS).
Results: After pretreatment-only PSM (157 pairs), NCRT and NCIT showed similar 2-year OS (78.3% vs. 77.6%, P=0.853) and DFS (70.9% vs. 70.2%, P=0.996), despite a significantly higher pCR rate with NCRT (37.6% vs. 13.4%, P<0.001). In the 60-day landmark analysis, adjuvant therapy was associated with a lower summary DFS hazard in the NCIT overlap population (HR, 0.62; 95% CI, 0.39–0.99; P=0.044), but not with OS. Among NCIT non-pCR patients, the summary DFS association remained (HR, 0.59; 95% CI, 0.35–0.99; P=0.045) and was strongest during early follow-up. Corresponding NCRT estimates were not statistically significant.
Conclusions: NCIT was associated with survival comparable to NCRT despite a lower pCR rate. Among patients who did not achieve pCR after NCIT, postoperative adjuvant therapy was associated with a lower early DFS hazard, whereas a statistically significant association was not demonstrated after NCRT. These subgroup findings are exploratory and do not establish a differential treatment effect between neoadjuvant regimens. Prospective validation is warranted.
European Journal of Surgical Oncology , résumé, 2026