Early Recurrence Patterns After Neoadjuvant Chemoradiotherapy and Chemoimmunotherapy in Oesophageal Squamous Cell Carcinoma: A Multicentre Study
Abstract
Objectives: The goal of this study was to compare early recurrence patterns and survival outcomes between neoadjuvant chemoimmunotherapy (NCIT) and neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced oesophageal squamous cell carcinoma.
Methods: This retrospective cohort study included 1428 patients with stage IIB-IVA esophageal squamous cell carcinoma who underwent NCIT or NCRT followed by a radical surgical procedure. Outcomes included overall survival (OS), recurrence-free survival, loco-regional recurrence, distant metastasis, and post-recurrence survival. Propensity score matching (1:1 ratio, 0.1 caliper; balance threshold: standardized mean difference <0.10) and multivariable Cox regression were utilized.
Results: After propensity score matching (532 patients per group), the NCIT group exhibited better 3-year OS (72.2% vs 60.9%; hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.56-0.85; P < .001) and recurrence-free survival (67.8% vs 59.3%; HR, 0.70; 95% CI, 0.57-0.86; P < .001) than the NCRT group. The NCIT group also had lower rates of early overall recurrence (131 [24.6%] vs 196 [36.8%]; P < .001) and early distant metastasis (73 [13.7%] vs 125 [23.5%]; P < .001) than the NCRT group. Multivariable regression analysis identified NCRT (vs NCIT), higher ypN stage, and not achieving a major pathological response as independent risk factors for both early overall recurrence and early distant metastasis. Among patients who experienced early recurrence, post-recurrence survival did not differ between the 2 modalities (HR, 0.81; 95% CI, 0.63-1.04; P = .086). Although the NCRT group had a higher major pathological response rate, NCIT was associated with better early recurrence control even among patients achieving a major pathological response (HR, 0.61; 95% CI, 0.47-0.84; P < .001).
Conclusions: Compared with NCRT, NCIT is associated with a lower incidence of early recurrence, particularly distant metastasis, which may contribute to the observed OS advantage. The poor prognosis after early recurrence highlights the need for intensified post-operative surveillance in high-risk patients.
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BibTeX
@article{sun2026early,
title = {{Early Recurrence Patterns After Neoadjuvant Chemoradiotherapy and Chemoimmunotherapy in Oesophageal Squamous Cell Carcinoma: A Multicentre Study}},
author = {Cien Sun and Chunji Chen and Hua Sun and Hao Liu and Qianyi Chen and Zimin Wang and Jiawen Chen and William C Cho and Zhigang Li and Zhichao Liu and Dehua Ma and Minhua Ye and Chunguo Wang and QinYa Wang and Xuefeng Leng and Yongtao Han and Qifeng Wang and Jiahua Lv and Hainan Chen and Jinbo Zhao and Xiaolong Yan and Huilai Lv and Ziqiang Tian and Changchun Wang and Liwei Xu and Youhua Jiang and Zhengyang Zhang and Qihong Zhong and Jiangbo Lin and Xinyu Mei and Xiaoyang Li and Dong Qian and Chengchu Zhu and Xufeng Guo and Jianfei Shen},
journal = {European Journal of Cardio-Thoracic Surgery},
year = {2026},
month = sep,
doi = {10.1093/ejcts/ezag219},
url = {https://doi.org/10.1093/ejcts/ezag219},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Early Recurrence Patterns After Neoadjuvant Chemoradiotherapy and Chemoimmunotherapy in Oesophageal Squamous Cell Carcinoma: A Multicentre Study
AU - Cien Sun
AU - Chunji Chen
AU - Hua Sun
AU - Hao Liu
AU - Qianyi Chen
AU - Zimin Wang
AU - Jiawen Chen
AU - William C Cho
AU - Zhigang Li
AU - Zhichao Liu
AU - Dehua Ma
AU - Minhua Ye
AU - Chunguo Wang
AU - QinYa Wang
AU - Xuefeng Leng
AU - Yongtao Han
AU - Qifeng Wang
AU - Jiahua Lv
AU - Hainan Chen
AU - Jinbo Zhao
AU - Xiaolong Yan
AU - Huilai Lv
AU - Ziqiang Tian
AU - Changchun Wang
AU - Liwei Xu
AU - Youhua Jiang
AU - Zhengyang Zhang
AU - Qihong Zhong
AU - Jiangbo Lin
AU - Xinyu Mei
AU - Xiaoyang Li
AU - Dong Qian
AU - Chengchu Zhu
AU - Xufeng Guo
AU - Jianfei Shen
PY - 2026
DA - 2026/09/08
JO - European Journal of Cardio-Thoracic Surgery
DO - 10.1093/ejcts/ezag219
UR - https://doi.org/10.1093/ejcts/ezag219
AB - Objectives: The goal of this study was to compare early recurrence patterns and survival outcomes between neoadjuvant chemoimmunotherapy (NCIT) and neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced oesophageal squamous cell carcinoma. Methods: This retrospective cohort study included 1428 patients with stage IIB-IVA esophageal squamous cell carcinoma who underwent NCIT or NCRT followed by a radical surgical procedure. Outcomes included overall survival (OS), recurrence-free survival, loco-regional recurrence, distant metastasis, and post-recurrence survival. Propensity score matching (1:1 ratio, 0.1 caliper; balance threshold: standardized mean difference <0.10) and multivariable Cox regression were utilized. Results: After propensity score matching (532 patients per group), the NCIT group exhibited better 3-year OS (72.2% vs 60.9%; hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.56-0.85; P < .001) and recurrence-free survival (67.8% vs 59.3%; HR, 0.70; 95% CI, 0.57-0.86; P < .001) than the NCRT group. The NCIT group also had lower rates of early overall recurrence (131 [24.6%] vs 196 [36.8%]; P < .001) and early distant metastasis (73 [13.7%] vs 125 [23.5%]; P < .001) than the NCRT group. Multivariable regression analysis identified NCRT (vs NCIT), higher ypN stage, and not achieving a major pathological response as independent risk factors for both early overall recurrence and early distant metastasis. Among patients who experienced early recurrence, post-recurrence survival did not differ between the 2 modalities (HR, 0.81; 95% CI, 0.63-1.04; P = .086). Although the NCRT group had a higher major pathological response rate, NCIT was associated with better early recurrence control even among patients achieving a major pathological response (HR, 0.61; 95% CI, 0.47-0.84; P < .001). Conclusions: Compared with NCRT, NCIT is associated with a lower incidence of early recurrence, particularly distant metastasis, which may contribute to the observed OS advantage. The poor prognosis after early recurrence highlights the need for intensified post-operative surveillance in high-risk patients.
SN - 1010-7940
SN - 1873-734X
ER -