ORIGINAL RESEARCH article

Front. Oncol.

Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1573597

Impact of neoadjuvant immunotherapy combined with chemotherapy or chemoradiotherapy on postoperative safety in locally advanced esophageal squamous cell carcinoma: a propensity score-matched retrospective cohort study

Provisionally accepted
Yixin  LiYixin LiGang  XiaoGang XiaoBo  YangBo YangYidan  HongYidan HongZeng  ChenZeng ChenLingling  GuLingling GuCheng  KongCheng KongLijun  ZhaoLijun ZhaoZihao  ZhuZihao ZhuQicen  XuQicen XuYu  ChenYu ChenXiangzhi  ZhuXiangzhi ZhuMing  JiangMing JiangNing  JiangNing Jiang*
  • Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China

The final, formatted version of the article will be published soon.

The combination of immunotherapy with neoadjuvant chemotherapy (nICT) or chemoradiotherapy (nICRT) represents a novel treatment approach for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This study aimed to compare postoperative complications between patients who underwent esophagectomy directly and those who received surgery following neoadjuvant immunotherapy combining treatments (nIComT) including nICT or nICRT.A retrospective analysis was conducted on patients with LA-ESCC at our center. A 1:1 propensity score matching (PSM) was used to eliminate baseline characteristics differences. The primary endpoint was postoperative complications, which were assessed based on the Esophageal Cancer Complications Consensus Group (ECCG) criteria, and the severity was evaluated according to the Clavien-Dindo classification.Results: After PSM, 116 matched patients were analyzed in both the surgery-alone and nIComT group. The overall complication rates between the two groups were similar (51.7% vs 56.0%, P=0.510). Incidence of cardiovascular complications, most of which were grade I and II, was increased in the nIComT group compared with the surgery-alone group(P=0.003). The higher rate of cardiovascular complications mainly due to hypotension (52.6% vs 42.2%, P=0.004) requiring intervention including the use of vasopressors, or transfusion. Additionally, more patients in the nIComT group received perioperative transfusion (34.5% vs 14.7%, P<0.001), as well as an extended operation duration (276±66min vs 246±63min, P<0.001), when compared to the surgery-alone group. The logistic regression analyses of potential risk factors for cardiovascular complications showed that receiving neoadjuvant treatment was independently associated with cardiovascular complications (OR=2.03, 95% CI=1.15-3.57,Conclusion:Our study highlights an increased risk of cardiovascular complications among patients received nIComT, underscoring the significance of postoperative circulatory interventions. Further prospective studies are needed for validation.

Keywords: Esophagectomy, Esophageal squamous cell carcinoma (ESCC), neoadjuvant immunotherapy, perioperative complications, Immune checkpoint inhibitors (ICIs)

Received: 09 Feb 2025; Accepted: 30 Apr 2025.

Copyright: © 2025 Li, Xiao, Yang, Hong, Chen, Gu, Kong, Zhao, Zhu, Xu, Chen, Zhu, Jiang and Jiang. 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: Ning Jiang, Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China

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