Comparison of efficacy and safety in two versus three cycles of neoadjuvant immunotherapy plus chemotherapy for esophageal squamous cell carcinoma.

PURPOSE: This research aimed to compare the efficacy and safety in two versus three cycles of neoadjuvant immunotherapy plus chemotherapy for esophageal squamous cell carcinoma. MATERIALS AND METHODS: Patients with esophageal squamous cell carcinoma receiving neoadjuvant immunotherapy plus albumin-bound paclitaxel and platinum-based chemotherapy followed by esophagectomy from December 2020 to May 2024 were retrospectively analyzed. The therapeutic efficacy, adverse reactions, and postoperative complications between the two- and three-cycle groups were analyzed using chi-square test and independent sample t-test. The overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method with log-rank test. RESULTS: A total of 138 esophageal squamous cell carcinoma patients receiving neoadjuvant immunotherapy plus chemotherapy were enrolled. The R0 resection rates were 94.5% and 95.7% in the two- and three-cycle groups, respectively (P = 0.554). The pathological complete response and major pathological response rates in the two-cycle group were 19.8% and 40.7%, while they were 21.3% and 38.3% in the three-cycle group, respectively, with no significant differences (P = 0.836 and P = 0.788). More anemia cases appeared in the three-cycle group (27.7% vs. 13.2%, P = 0.036). There were no significant differences between the two- and three-cycle groups in terms of anastomotic fistula, pulmonary infection, chylothorax, and multiple organ dysfunction syndrome. Additionally, The 3-year OS rates of patients in the two- and three-cycle groups were 80.1% and 74.5%, respectively, without significant difference (P = 0.421). The 3-year PFS rates in the two- and three-cycle groups were 62.5% and 65.8%, respectively, without significant difference either (P = 0.966). CONCLUSIONS: Two-cycle neoadjuvant immunotherapy combined with albumin-bound paclitaxel and platinum based chemotherapy can be an effective, safe, and optional neoadjuvant strategy for esophageal squmous cell carcinoma patients.