Definitive radiotherapy versus surgery after neoadjuvant immunochemotherapy for locally advanced esophageal squamous cell carcinoma: a propensity score-matched study of efficacy and safety
- 1Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
Abstract
Background: The optimal local treatment strategy for locally advanced esophageal squamous cell carcinoma (LA-ESCC) following neoadjuvant immunochemotherapy (NICT) remains controversial. This study aimed to compare the survival outcomes and recurrence patterns of radical surgery and definitive radiotherapy (RT) following NICT in patients with LA-ESCC.
Methods: Patients with LA-ESCC who underwent NICT (2019–2023) were enrolled and categorized into surgery or RT groups. Propensity score matching (PSM) and Kaplan-Meier methods were used to estimate progression-free survival (PFS) and overall survival (OS). The differences in recurrence patterns between the two groups were compared.
Results: A total of 278 patients were included, comprising 218 (78.4%) and 60 (21.6%) patients in the surgery and RT groups, respectively. After PSM, the surgery group (n=117) maintained a significant OS benefit over the RT group (n=60) (3-year OS rates: 72.1% vs. 59.5%; P = 0.028), whereas the PFS rates were comparable between the two groups (3-year PFS rates: 59.4% vs. 46.9%; P = 0.12). For patients with upper esophageal cancer, RT showed a trend toward improved survival (3-year PFS rates: 76.9% vs. 55.5%, P = 0.34; 3-year OS rates: 74.0% vs. 61.8%, P = 0.50). Among the responders after NICT (near-cCR/cPR), PFS and OS were similar between the surgery and RT groups (3-year PFS rates: 68.9% vs. 66.9%, P = 0.64; 3-year OS rates: 80.2% vs. 70.7%, P = 0.20). Regional lymph node recurrence predominated in the surgery group (50.0%), whereas locoregional esophageal recurrence was most frequent in the RT group (37.0%). The treatment-related mortality rates were 0.8% (1/117) in the surgery group and 1.7% (1/60) in the RT group, indicating the overall safety of the treatments.
Conclusions: Radical surgery remains the standard treatment for LA-ESCC after NICT. Definitive RT may be an organ-preserving option in selected patients, especially those with upper esophageal cancer or a favorable response to NICT.
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BibTeX
@article{an2026definitive,
title = {{Definitive radiotherapy versus surgery after neoadjuvant immunochemotherapy for locally advanced esophageal squamous cell carcinoma: a propensity score-matched study of efficacy and safety}},
author = {Qiuying An and Yage Jia and Menglu Liu and Liyuan Fu and Jingxin Bai and Zihan Zhang and Jin Yan and Yajing Wang and Hongshan Ji and Yuhao Su and Ping Zhang and Zhiguo Zhou},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1885302},
url = {https://doi.org/10.3389/fonc.2026.1885302},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Definitive radiotherapy versus surgery after neoadjuvant immunochemotherapy for locally advanced esophageal squamous cell carcinoma: a propensity score-matched study of efficacy and safety
AU - Qiuying An
AU - Yage Jia
AU - Menglu Liu
AU - Liyuan Fu
AU - Jingxin Bai
AU - Zihan Zhang
AU - Jin Yan
AU - Yajing Wang
AU - Hongshan Ji
AU - Yuhao Su
AU - Ping Zhang
AU - Zhiguo Zhou
PY - 2026
DA - 2026/10/12
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1885302
UR - https://doi.org/10.3389/fonc.2026.1885302
AB - Background: The optimal local treatment strategy for locally advanced esophageal squamous cell carcinoma (LA-ESCC) following neoadjuvant immunochemotherapy (NICT) remains controversial. This study aimed to compare the survival outcomes and recurrence patterns of radical surgery and definitive radiotherapy (RT) following NICT in patients with LA-ESCC. Methods: Patients with LA-ESCC who underwent NICT (2019–2023) were enrolled and categorized into surgery or RT groups. Propensity score matching (PSM) and Kaplan-Meier methods were used to estimate progression-free survival (PFS) and overall survival (OS). The differences in recurrence patterns between the two groups were compared. Results: A total of 278 patients were included, comprising 218 (78.4%) and 60 (21.6%) patients in the surgery and RT groups, respectively. After PSM, the surgery group (n=117) maintained a significant OS benefit over the RT group (n=60) (3-year OS rates: 72.1% vs. 59.5%; P = 0.028), whereas the PFS rates were comparable between the two groups (3-year PFS rates: 59.4% vs. 46.9%; P = 0.12). For patients with upper esophageal cancer, RT showed a trend toward improved survival (3-year PFS rates: 76.9% vs. 55.5%, P = 0.34; 3-year OS rates: 74.0% vs. 61.8%, P = 0.50). Among the responders after NICT (near-cCR/cPR), PFS and OS were similar between the surgery and RT groups (3-year PFS rates: 68.9% vs. 66.9%, P = 0.64; 3-year OS rates: 80.2% vs. 70.7%, P = 0.20). Regional lymph node recurrence predominated in the surgery group (50.0%), whereas locoregional esophageal recurrence was most frequent in the RT group (37.0%). The treatment-related mortality rates were 0.8% (1/117) in the surgery group and 1.7% (1/60) in the RT group, indicating the overall safety of the treatments. Conclusions: Radical surgery remains the standard treatment for LA-ESCC after NICT. Definitive RT may be an organ-preserving option in selected patients, especially those with upper esophageal cancer or a favorable response to NICT.
SN - 2234-943X
ER -