ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1700400
This article is part of the Research TopicCheckpoint Immunotherapy: Reshaping the Landscape of Gastrointestinal Cancer Treatment - Volume IIView all 4 articles
Residual pattern of primary tumor and lymph node in ESCC treated with nCRT with or without pembrolizumab: an analysis from a prospective cohort
Provisionally accepted
- Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Background: Neoadjuvant concurrent chemoradiotherapy (nCRT) is recommended as the standard-of-care for locally advanced esophageal squamous cell carcinoma (ESCC). Adding immunotherapy to nCRT (nICRT) has gained attention in clinical practice. We evaluated the differences in clinicopathologic outcomes and the patterns of lymphatic metastasis in patients receiving nCRT and nICRT for locally advanced ESCC. Methods: A total of 208 ESCC patients who completed transthoracic esophagectomy after neoadjuvant treatment were enrolled. Clinicopathologic parameters and the rates of lymph node metastasis in each station classified by both 8th edition of American Joint Committee on Cancer (AJCC) esophageal cancer staging system and 11th edition of Japanese Classification of Esophageal Cancer (JCEC) standard were recorded and evaluated. Results: The rate of pathological complete regression (pCR) and major pathological regression (MPR) was 44.9% in nICRT vs. 37.0% in nCRT (P=0.263) and 79.5% in nICRT vs. 65.4% in nCRT (P=0.024), respectively. The common sites of lymph node metastasis after neoadjuvant treatment were station 112pulL (8.3%) followed by station 104L (4.9%), station 7 (4.5%) and station 3a (4.3%) according to 11th JCEC standard. Compared with nCRT, nICRT can significantly reduce the rate of lymph node metastasis in station 2R (0.8% vs. 4.6%, P=0.039) classified by AJCC system, and station 106recR (0.8% vs. 4.6%, P=0.042) and station 20 (0 vs. 12.5%, P=0.030) classified by JCEC standard. Conclusion: nICRT followed by surgery may lead to a promising pathological response. For patients with lymph nodes metastasis in certain regions, nICRT should be considered as a better preoperative treatment option.
Keywords: esophageal squamous cell carcinoma, neoadjuvant immunochemoradiotherapy, Neoadjuvant chemoradiotherapy, primary tumor residual, Lymph node spread
Received: 06 Sep 2025; Accepted: 07 Oct 2025.
Copyright: © 2025 Qi, Han, Li, Li, Chen and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wei-Xiang Qi, qiweixiang1113@163.com
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