ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Efficacy of Neoadjuvant Immunochemotherapy in Locally Advanced Esophageal Squamous Cell Carcinoma: A Prospective Cohort Study with Propensity-Score Matching
Provisionally accepted
- 1Shandong Provincial Hospital, Jinan, China
- 2Jining Medical University, Jining, China
- 3Jining No 1 People's Hospital, Jining, China
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Background: This study compared the efficacy of neoadjuvant immunochemotherapy (nICT) followed by surgery versus upfront surgery for locally advanced esophageal squamous cell carcinoma (ESCC). Methods: In this prospective controlled trial (2020-2025), 623 stage II–IIIB ESCC patients were included; 192 received nICT (cisplatin, nab-paclitaxel, sintilimab) before surgery, and 431 underwent direct surgery. Propensity-score matching (PSM) and overlap weighting were used to adjust for baseline confounders. Results: After PSM (144 pairs), the nICT group showed significantly improved progression-free survival (PFS; HR=0.31, p<0.001) and overall survival (OS; HR=0.42, p=0.002) compared to the upfront surgery group. The nICT group also had higher 1-/3-year PFS (88.8%/84.3% vs. 68.1%/52.8%) and OS rates (94.8%/84.7% vs. 89.6%/65.2%). Sensitivity analysis using overlap weighting confirmed these robust findings (PFS: HR=0.37, p<0.001; OS: HR=0.62, p=0.033). Conclusions: For locally advanced ESCC, neoadjuvant immunochemotherapy significantly improves both PFS and OS compared to upfront surgery, establishing it as a highly effective treatment strategy.
Keywords: esophageal squamous cell carcinoma, Neoadjuvant immunochemotherapy, PD-1 blockade, Propensity-score matching, overall survival, Progression-free survival
Received: 23 Sep 2025; Accepted: 15 Dec 2025.
Copyright: © 2025 Zhang, Hu, Sun, Wei, Zhang, Cai and Wang. 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: Gongchao Wang
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