Locoregional and distant recurrence after neoadjuvant chemoimmunotherapy versus chemoradiotherapy in esophageal squamous cell carcinoma: a focused meta-analysis.
4 affiliations
- 1Department of Thoracic Surgery, The First People's Hospital of Jiande, No. 599, Yanzhou Street, Jiande, Zhejiang Province, 311600, China.
- 2Department of Thoracic Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China.
- 3Department of Gastroenterology, The First People's Hospital of Jiande, Jiande, 311600, China.
- 4Department of Thoracic Surgery, The First People's Hospital of Jiande, No. 599, Yanzhou Street, Jiande, Zhejiang Province, 311600, China. [email protected].
Abstract
Background
Neoadjuvant chemoimmunotherapy (NCIT) is used for locally advanced esophageal squamous cell carcinoma (ESCC), but its effect on postoperative recurrence patterns remains uncertain. We compared overall, locoregional, and distant recurrence after NCIT versus neoadjuvant chemoradiotherapy (NCRT).Methods
PubMed/MEDLINE, Embase, Web of Science Core Collection, Scopus, and the Cochrane Library were searched through 01 May 2026. Eligible studies included patients with resectable or potentially resectable locally advanced ESCC who received NCIT or NCRT followed by radical esophagectomy. Recurrence outcomes were pooled as risk ratios (RRs), and disease-free survival or recurrence-free survival (DFS/RFS) and overall survival (OS) as hazard ratios (HRs), using random-effects models. Post hoc sensitivity analyses excluded studies with marked between-group follow-up imbalance.Results
Twenty comparative studies, all conducted in China, were included; 19 were retrospective observational studies and one was a randomized phase 2 trial. Five studies contributed to the overall-recurrence analysis, and six studies contributed to each of the locoregional- and distant-recurrence analyses. NCIT was associated with lower overall recurrence (RR 0.68, 95% CI 0.49-0.95; P = 0.03) and distant recurrence/metastasis (RR 0.62, 95% CI 0.43-0.89; P = 0.009), whereas locoregional recurrence did not differ significantly (RR 1.02, 95% CI 0.67-1.55; P = 0.92). In post hoc analyses excluding studies with marked follow-up imbalance, the locoregional estimate remained nonsignificant (RR 0.87, 95% CI 0.66-1.15), and the distant-recurrence/metastasis estimate was attenuated and no longer significant (RR 0.65, 95% CI 0.36-1.17). Ten studies contributed to OS, which favored NCIT (HR 0.67, 95% CI 0.48-0.93; P = 0.02; I² = 77%), whereas eight contributed to DFS/RFS, which did not differ significantly (HR 0.82, 95% CI 0.59-1.13; P = 0.21; I² = 74%).Conclusions
Compared with NCRT, NCIT was associated with fewer overall recurrences after radical esophagectomy for locally advanced ESCC. The primary distant-recurrence signal was not robust after excluding studies with marked follow-up imbalance, and no locoregional advantage was demonstrated. These findings do not establish therapeutic superiority and should be interpreted cautiously given the predominance of retrospective evidence, risk of bias, and substantial heterogeneity in survival analyses.
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BibTeX
@article{ruan2026locoregional,
title = {{Locoregional and distant recurrence after neoadjuvant chemoimmunotherapy versus chemoradiotherapy in esophageal squamous cell carcinoma: a focused meta-analysis.}},
author = {Yingding Ruan and Wenjun Cao and Chuan Long and Changjiang Li and Jianwei Han},
journal = {BMC cancer},
year = {2026},
month = sep,
doi = {10.1186/s12885-026-16944-w},
url = {https://europepmc.org/article/MED/42926222},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Locoregional and distant recurrence after neoadjuvant chemoimmunotherapy versus chemoradiotherapy in esophageal squamous cell carcinoma: a focused meta-analysis.
AU - Yingding Ruan
AU - Wenjun Cao
AU - Chuan Long
AU - Changjiang Li
AU - Jianwei Han
PY - 2026
DA - 2026/09/01
JO - BMC cancer
DO - 10.1186/s12885-026-16944-w
UR - https://europepmc.org/article/MED/42926222
AB - Background Neoadjuvant chemoimmunotherapy (NCIT) is used for locally advanced esophageal squamous cell carcinoma (ESCC), but its effect on postoperative recurrence patterns remains uncertain. We compared overall, locoregional, and distant recurrence after NCIT versus neoadjuvant chemoradiotherapy (NCRT).Methods PubMed/MEDLINE, Embase, Web of Science Core Collection, Scopus, and the Cochrane Library were searched through 01 May 2026. Eligible studies included patients with resectable or potentially resectable locally advanced ESCC who received NCIT or NCRT followed by radical esophagectomy. Recurrence outcomes were pooled as risk ratios (RRs), and disease-free survival or recurrence-free survival (DFS/RFS) and overall survival (OS) as hazard ratios (HRs), using random-effects models. Post hoc sensitivity analyses excluded studies with marked between-group follow-up imbalance.Results Twenty comparative studies, all conducted in China, were included; 19 were retrospective observational studies and one was a randomized phase 2 trial. Five studies contributed to the overall-recurrence analysis, and six studies contributed to each of the locoregional- and distant-recurrence analyses. NCIT was associated with lower overall recurrence (RR 0.68, 95% CI 0.49-0.95; P = 0.03) and distant recurrence/metastasis (RR 0.62, 95% CI 0.43-0.89; P = 0.009), whereas locoregional recurrence did not differ significantly (RR 1.02, 95% CI 0.67-1.55; P = 0.92). In post hoc analyses excluding studies with marked follow-up imbalance, the locoregional estimate remained nonsignificant (RR 0.87, 95% CI 0.66-1.15), and the distant-recurrence/metastasis estimate was attenuated and no longer significant (RR 0.65, 95% CI 0.36-1.17). Ten studies contributed to OS, which favored NCIT (HR 0.67, 95% CI 0.48-0.93; P = 0.02; I² = 77%), whereas eight contributed to DFS/RFS, which did not differ significantly (HR 0.82, 95% CI 0.59-1.13; P = 0.21; I² = 74%).Conclusions Compared with NCRT, NCIT was associated with fewer overall recurrences after radical esophagectomy for locally advanced ESCC. The primary distant-recurrence signal was not robust after excluding studies with marked follow-up imbalance, and no locoregional advantage was demonstrated. These findings do not establish therapeutic superiority and should be interpreted cautiously given the predominance of retrospective evidence, risk of bias, and substantial heterogeneity in survival analyses.
SN - 1471-2407
ER -