ORIGINAL RESEARCH article
Front. Med.
Sec. Gastroenterology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1524176
Immunotherapy in advanced esophageal squamous cell cancer: earlier or later?
Provisionally accepted
- 1Gaomi City People's Hospital, Weifang, Shandong Province, China
- 2Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong Province, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background and objective: Several large-scale phase III clinical trials have confirmed the survival benefit of immunotherapy in patients with locally advanced or metastatic esophageal cancer. The aim of this study is to investigate whether early use of immunotherapy can improve long-term survival.Methods: Patients with locally advanced or metastatic esophageal squamous cell cancer (ESCC) diagnosed from January 2018 to December 2021were retrospectively analyzed. According to the time of immunotherapy, patients were divided into early immunotherapy group (EIT group, first-line immunotherapy ) and late immunotherapy group (LIT group, second-line immunotherapy) . A 1:1 propensity score matching (PSM) was applied to balance the observable potential confounding factors between the two groups. The primary outcome was overall survival (OS).Results: A total of 359 patients were enrolled, after propensity score matching, the clinical features were well balanced between two groups included 107 patients each. The median OS was 15.7 months (95%CI: 12.81-18.59) in the EIT group and 17.7 months (95%CI: 14.89-20.57) in the LIT group, respectively. (P=0.185, HR=1.25). The PFS1 of patients were 8.7 months (95%CI: 7.53-9.87) and 7.6 months (95%CI: 5.90-9.30),respectively, and the difference was statistically significant (P=0.032, HR=0.72). The PFS2 of patients were 12.97months (95%CI: 11.37-14.58) and 12.93 months (95%CI: 11.65-14.21), respectively, and the difference was statistically significant(P=0.045,HR=0.73). Subgroup analysis showed that male patients with middle thoracic esophageal cancer, younger than 65 years old, only one site of metastasis, only lymph node progression, no combined radiotherapy after progression and TP (paclitaxel plus platinum) regimen chemotherapy may have greater benefits. COX multivariate analysis showed that the EIT group and the differentiation degree of tumor had an impact on overall survival (P： 0.03、 0.04, HR: 0.73、0.70).Conclusions: For patients with locally advanced or metastatic advanced ESCC, early immunotherapy can improve PFS without improving OS.
Keywords: Immunotherapy, Esophageal squamous cell cancer, overall survival, EIT, LiT
Received: 07 Nov 2024; Accepted: 17 Jun 2025.
Copyright: © 2025 Wei, Li, Liu, Sun, HUANG and Sun. 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 HUANG, Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, 250117, Shandong Province, China
Hongfu Sun, Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, 250117, Shandong Province, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.