Abstract:

Background and purpose: Radical surgery after neoadjuvant immunotherapy combined with chemotherapy (nICT) in patients with locally advanced esophageal squamous cell carcinoma (LAESCC) has good efficacy and safety, and it can improve the patients’ pathological complete remission (pCR) rate, main pathologic response (MPR) rate and R0 resection rate. The prognosis of patients with pCR/MPR after nICT is significantly better compared with patients without pCR. The prognosis of patients achieving pCR/MPR after neoadjuvant therapy has been demonstrated to be significantly better than that of patients with non-pCR/MPR. Therefore, finding predictive factors of pCR/MPR is beneficial for us to screen out the advantageous populations for combination therapy. The aim of this study was to investigate the value of clinical data of patients with LAESCC before and after nICT in predicting the degree of remission of different pathologies after radical surgery following neoadjuvant treatment and to observe the safety of the treatment. Methods: Data of patients with locally LAESCC who underwent radical surgery after nICT from January 2019 to June 2023 at the Affiliated Hospital of Chuanbei Medical College were collected. The clinical data of all patients as well as some blood, inflammation and nutritional indexes of patients before and after neoadjuvant therapy were collected, and the patients were grouped according to the different degrees of pathological remission after neoadjuvant therapy. Data were analyzed by multi-group comparative analysis of variance (ANOVA) and LSD-t post-hoc test. We explored the factors that had an influence on the different degrees of pathological remission, and collected and recorded the patients’ adverse reactions during neoadjuvant therapy as well as their eventual surgeries. Results: Data of 62 patients with LAESCC treated with nICT who underwent radical surgery were collected. Only one patient showed grade 4 myelosuppression during neoadjuvant therapy, and the rest of the patients had adverse reactions ≤grade 2. The R0 resection rate of the surgery was 98.39%. The present study was compared with the previous studies of LAESCC treated with neoadjuvant chemotherapy followed by radical surgery performed in Affiliated Hospital of Chuanbei Medical College. Compared with the previous studies conducted in our center, no significant difference was observed in terms of operation time, intraoperative bleeding, postoperative hospitalization time and surgical complications. The postoperative pathologic results showed that the pCR rate was 22.58% (14/62), and the MPR rate was 40.32% (25/62). According to the different tumor regression grade (TRG) after surgery, patients were divided into 3 groups of TRG1, TRG2 and TRG3-4, and differences in the platelet distribution width (PDW) before neoadjuvant therapy and the preoperative neutrophil-to-lymphocyte ratio (NLR) after neoadjuvant therapy were statistically significant among the 3 groups (P<0.05). Further intra-group two-by-two comparisons of PDW before neoadjuvant therapy and NLR before surgery after neoadjuvant therapy were performed for the three groups of patients, respectively, and it was found that the PDW and NLR in the TRG2 group were lower compared with the TRG3-4 group, and the differences were statistically significant (P<0.05). Conclusion: Radical surgery after nICT treatment in patients with LAESCC can have high R0 resection rate, pCR rate, MPR rate and reliable safety, and the lower PDW of patients before neoadjuvant therapy and the lower NLR of patients before surgery after neoadjuvant therapy predict better pathological remission efficacy.

Key words: Esophageal squamous cell carcinoma, Neoadjuvant immunotherapy combined with chemotherapy, Radical surgery, Pathological remission degree, Safety