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Background <p>Immune checkpoint inhibitors have demonstrated preliminary safety and efficacy in treating borderline resectable esophageal squamous cell carcinoma (BR-ESCC). We aimed to compare treatment and survival outcomes between patients with locally advanced resectable ESCC (cT3r) and those with borderline resectable ESCC (cT3br) who underwent surgery following neoadjuvant immunochemotherapy (NICT).</p> Methods <p>In this retrospective cohort, 114 patients with clinically staged T3 ESCC who received NICT were screened. Ultimately, 102 patients who underwent surgery were analyzed, categorized into cT3r (<i>n</i> = 62) and cT3br (n = 40) groups based on the likelihood of adjacent vital organ invasion as observed on pre-treatment CT scans.</p> Results <p>Among patients with cT3br disease, the conversion-to-resectability rate after NICT was 76.9% (40/52). Surgical parameters and postoperative complication rates were comparable between the two groups (all <i>P</i> &gt; 0.05). Although the non-R0 resection rate was significantly higher in the cT3br group than in the cT3r group (20.0% vs 3.2%, <i>P</i> = 0.005), no significant differences were observed in postoperative overall survival (OS) or disease-free survival (DFS) between the two groups (3-year OS: 76% vs 67%, <i>P</i> = 0.453; 3-year DFS: 69% vs 47%, <i>P</i> = 0.155). Non-R0 resection was significantly associated with worse OS (<i>P</i> = 0.001) and showed a trend toward association with DFS (<i>P</i> = 0.069).</p> Conclusion <p>In this single-arm cohort study, NICT demonstrated potential as a conversion therapy for BR-ESCC, yielding promising surgical conversion and survival outcomes that approached those of patients with cT3r disease.</p>

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Conversion surgical after neoadjuvant immunochemotherapy achieves survival comparable to initially resectable disease in borderline resectable esophageal cancer

  • 期刊论文

  • 发表日期：

    2026年3月28日

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  • Binwen Xu,
  • Hanxiao Wang,
  • Chengcheng Zhang,
  • Tao Luo,
  • Jie Xiong,
  • Xingqiang Ran,
  • Junhong Liu,
  • Guidong Shi,
  • Maoyong Fu

摘要

Background

Immune checkpoint inhibitors have demonstrated preliminary safety and efficacy in treating borderline resectable esophageal squamous cell carcinoma (BR-ESCC). We aimed to compare treatment and survival outcomes between patients with locally advanced resectable ESCC (cT3r) and those with borderline resectable ESCC (cT3br) who underwent surgery following neoadjuvant immunochemotherapy (NICT).

Methods

In this retrospective cohort, 114 patients with clinically staged T3 ESCC who received NICT were screened. Ultimately, 102 patients who underwent surgery were analyzed, categorized into cT3r (n = 62) and cT3br (n = 40) groups based on the likelihood of adjacent vital organ invasion as observed on pre-treatment CT scans.

Results

Among patients with cT3br disease, the conversion-to-resectability rate after NICT was 76.9% (40/52). Surgical parameters and postoperative complication rates were comparable between the two groups (all P > 0.05). Although the non-R0 resection rate was significantly higher in the cT3br group than in the cT3r group (20.0% vs 3.2%, P = 0.005), no significant differences were observed in postoperative overall survival (OS) or disease-free survival (DFS) between the two groups (3-year OS: 76% vs 67%, P = 0.453; 3-year DFS: 69% vs 47%, P = 0.155). Non-R0 resection was significantly associated with worse OS (P = 0.001) and showed a trend toward association with DFS (P = 0.069).

Conclusion

In this single-arm cohort study, NICT demonstrated potential as a conversion therapy for BR-ESCC, yielding promising surgical conversion and survival outcomes that approached those of patients with cT3r disease.