Efficacy and safety of immune checkpoint inhibitors plus chemotherapy in esophageal cancer patients with liver metastases.

BACKGROUND: The liver represents a common site of distant metastasis in patients with esophageal cancer (EC). Conventional chemotherapy (CMT) presents limited efficacy for EC, and EC patients with liver metastases typically experience a poor prognosis, highlighting an urgent need to explore novel treatment approaches. This study evaluated the overall efficacy and safety of CMT vs CMT combined with immune checkpoint inhibitors (ICIs) in the treatment of EC patients with liver metastases. Furthermore, prognostic factors influencing outcomes in this patient population were identified. AIM: To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors. METHODS: This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024. Patients receiving CMT were compared with those receiving CMT + ICI. Analyzed variables included clinicopathological features, treatment history, characteristics of metastasis, systemic and local treatments, overall survival (OS), and treatment-related adverse events (TRAEs). Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models. Finally, efficacy outcomes and TRAE profiles were compared between the two groups. RESULTS: A significant difference in median OS was identified between the two groups (10.8 months in the CMT group vs 20.8 months in the CMT + ICI group, P = 0.004). The CMT + ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months (P < 0.001). Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate. Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases: Karnofsky Performance Status score ≥ 70, receipt of local therapy for liver metastases, and the number of cycles of CMT and immunotherapy received. Furthermore, the incidence of TRAEs did not significantly differ between the CMT + ICI and CMT groups. CONCLUSION: For EC patients with liver metastases, the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone, while maintaining manageable TRAEs.