National Cancer Center/National Clinical Research Center for Cancer Cancer Hospital, CAMS & PUMC Beijing, Beijing
Y. Liu1, Y. Bao1, Y. Wang2, Z. Ma1, Y. Men3, J. Qin4, L. Xue5, J. Wang6, and Z. Hui3; 1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2Department of Mathematics & Statistics, Lancaster University, Lancaster, United Kingdom, 3Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 4Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 5Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 6Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
Purpose/Objective(s): The investigation of immunotherapy combined with chemoradiation (nICRT) for resectable esophageal cancer is a focal point of interest in clinical research. However, there is a lack of comprehensive systematic analyses of these emerging studies. This meta-analysis aimed to assess the short-term efficacy, safety and survival outcomes of nICRT in esophageal cancer. Materials/
Methods: A systematic search across PubMed, Embase, Cochrane Library and conferences was conducted for studies published until August 15, 2023. Inclusion criteria were studies on resectable esophageal cancer treated with nICRT. Data on pathological complete response (pCR), major pathological response (MPR), treatment-related adverse events (TRAEs), overall survival (OS), and disease-free survival (DFS) were extracted and analyzed. If heterogeneity was substantial (I² statistic >50%), a random-effects model was utilized; otherwise, the common-effects model was applied. Results: Sixteen studies involving 494 patients were included. The pooled pCR rate was 38% (95% CI, 30-47%; I2 = 68%). The MPR rate was 74% (95% CI, 65-81%; I2 = 54%). The incidence of = grade 3 TRAEs was 53% (95% CI, 30-76%; I2 = 86%). The 1-year and 2-year OS rates were 83.8% (95% CI, 79.6-88.3%) and 65.2% (95% CI, 59.4-71.6%), respectively. The 1-year and 2-year DFS rates were 74.7% (95% CI, 69.7-80.0%) and 52.6% (95% CI, 46.5-59.6%), respectively. Subgroup analyses showed higher pCR (p<0.001) and MPR (p<0.001) for squamous cell carcinoma compared to adenocarcinoma, but similar survival outcomes. Conclusion: Neoadjuvant immunotherapy combined with chemoradiation demonstrates favorable short-term efficacy and survival, with acceptable safety profiles in esophageal cancer. However, further validation in larger, randomized trials with longer follow-up is needed to confirm these findings.
