Clinical Outcomes of Neoadjuvant Chemoimmunotherapy Versus Chemoradiation Combined with Immunotherapy in Locally Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis
In brief
Radiation boosts complete response to 41% but increases lung complications
In a propensity-matched cohort of 124 patients per arm, adding radiotherapy to neoadjuvant chemoimmunotherapy raised the pathologic complete response rate to 41% versus 19% with chemoimmunotherapy alone, while postoperative pulmonary complications rose to 37% from 17%. Despite the better tumor kill, overall and disease-free survival were unchanged, leaving the survival benefit of the added radiation uncertain.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 17 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Xin Xiao, Pinhao Fang, Chengyi Mao, Jianfeng Zhou, Yushang Yang, Siyuan Luan, et al.
- PMID
- 42606653
- DOI
- 10.1245/s10434-026-20415-8
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (paper of the day, 21 August 2026): Chemoimmunotherapy vs chemoradiation‑immunotherapy in ESCC
Abstract
BACKGROUND: Neoadjuvant chemoimmunotherapy (NCIT) has emerged as a promising strategy for patients with esophageal squamous cell carcinoma (ESCC). However, whether neoadjuvant chemoradiation-immunotherapy (NCRI) can further improve therapeutic efficacy remains uncertain. METHODS: This study prospectively enrolled and retrospectively analyzed 557 consecutive patients with locally advanced ESCC who underwent neoadjuvant therapy between December 2019 and January 2025. The participants were stratified into two treatment cohorts: those receiving NCIT and those undergoing NCRI. To mitigate potential selection bias and ensure balanced baseline characteristics between groups, a 1:1 propensity score-matching (PSM) protocol was implemented incorporating multiple clinically relevant covariates to assess short-term pathologic outcomes and long-term survival. RESULTS: After PSM, these baseline characteristics were well balanced, with 124 patients in each group. The NCRI group demonstrated superior pathologic outcomes, with a significantly higher pathologic complete response (pCR) rate (41.1% vs 19.4%; P < 0.001) and a lower tumor regression score (TRS; P < 0.001), but also a higher incidence of postoperative pulmonary complications (37.1% vs 16.9%; P < 0.001). Despite these differences, no significant variation in overall survival (OS; P = 0.837) or disease-free survival (DFS; P = 0.429) was observed between the two groups during the follow-up period. CONCLUSIONS: The addition of radiotherapy to NCIT significantly improved pCR rates compared with NCIT alone, but was associated with a higher incidence of postoperative pulmonary complications. However, this pathologic benefit did not translate into superior long-term survival outcomes in either OS or DFS.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.