Conversion surgical after neoadjuvant immunochemotherapy achieves survival comparable to initially resectable disease in borderline resectable esophageal cancer.

Résumé

BACKGROUND: Immune checkpoint inhibitors have demonstrated preliminary safety and efficacy in treating borderline resectable esophageal squamous cell carcinoma (BR-ESCC). We aimed to compare treatment and survival outcomes between patients with locally advanced resectable ESCC (cT3r) and those with borderline resectable ESCC (cT3br) who underwent surgery following neoadjuvant immunochemotherapy (NICT).METHODS: In this retrospective cohort, 114 patients with clinically staged T3 ESCC who received NICT were screened. Ultimately, 102 patients who underwent surgery were analyzed, categorized into cT3r (n = 62) and cT3br (n = 40) groups based on the likelihood of adjacent vital organ invasion as observed on pre-treatment CT scans.RESULTS: Among patients with cT3br disease, the conversion-to-resectability rate after NICT was 76.9% (40/52). Surgical parameters and postoperative complication rates were comparable between the two groups (all P > 0.05). Although the non-R0 resection rate was significantly higher in the cT3br group than in the cT3r group (20.0% vs 3.2%, P = 0.005), no significant differences were observed in postoperative overall survival (OS) or disease-free survival (DFS) between the two groups (3-year OS: 76% vs 67%, P = 0.453; 3-year DFS: 69% vs 47%, P = 0.155). Non-R0 resection was significantly associated with worse OS (P = 0.001) and showed a trend toward association with DFS (P = 0.069).CONCLUSION: In this single-arm cohort study, NICT demonstrated potential as a conversion therapy for BR-ESCC, yielding promising surgical conversion and survival outcomes that approached those of patients with cT3r disease.