ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Neoadjuvant chemotherapy versus surgery alone in locally advanced esophageal squamous cell carcinoma: A propensity-matched real-world study
Provisionally accepted
- 1Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- 2Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- 3Department of Thoracic Surgery, The Fourth Hospital of Heibei Medical University, Shijiazhuang, China
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Bsckground: The therapeutic value of neoadjuvant chemotherapy (NAC) for locally advanced esophageal squamous cell carcinoma (ESCC) remains uncertain compared to surgery alone (SA), particularly in real-world settings. This study utilized propensity score matching (PSM) to compare survival outcomes between NAC and surgery in a well-balanced ESCC cohort, while assessing pathological complete response (pCR) and prognostic factors to guide clinical dec ision-making. Methods: The study conducted a retrospective analysis of 690 patients with locally advanced ESCC (T3 -4aN0-3M0) who underwent radical esophagectomy between 2009 and 2019. PSM was employed to balance baseline characteristics, yielding 452 matched patients (135 NAC, 317 SA). NAC consisted of platinum-based doublet regimens. Survival outcomes, including disease-free survival (DFS) and overall survival (OS), were analyzed using Kaplan-Meier and Cox regression methods. pCR were assessed using CAP criteria. Results: NAC significantly improved 5-year DFS (28.7% vs. 18.5%, P=0.001) and OS (37.9% vs. 24.2%, P=0.001) compared to SA. Patients achieving pCR (11.9%) exhibited superior DFS (5-year: 55.0% vs. 18.5%, P=0.010) and OS (5-year: 59.8% vs. 35.0%, P=0.019). Multivariate analysis identified NAC, histologic grade, ypN stage, vessel/nerve invasion, and pCR as independent prognostic factors. Conclusions: This real-world data supports that NAC significantly improves survival outcomes compared to SA in locally advanced ESCC. pCR post-NAC independently predicted improved OS.
Keywords: esophageal squamous cell carcinoma, Pathological complete response, Neoadjuvant chemotherapy, Survival benefits, Survival outcomes
Received: 25 Aug 2025; Accepted: 06 Nov 2025.
Copyright: © 2025 Wang, Yue, Li, Yang, Liu and Yao. 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:
Jun Feng Liu, liujf@hebmu.edu.cn
Jifang Yao, yaojifang2023@126.com
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