Neoadjuvant Chemoimmunotherapy for Elderly Patients with Locally Advanced Resectable Esophageal Squamous Cell Carcinoma.

Abstract

This study explored the safety and clinical efficacy of neoadjuvant immunotherapy combined with chemotherapy (NAIC) for elderly patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC). All patients aged >70 years who underwent esophagectomy for locally advanced resectable ESCC in our hospital from February 2018 to June 2024 were retrospectively reviewed. Patients were classified into either a "surgery alone" group or an "NAIC plus surgery" group. In the NAIC plus surgery group, patients received two to four cycles of NAIC. The patients' clinical characteristics and outcomes were analyzed using a propensity score-matched comparison and a Cox regression model. Overall, 278 patients were included in the study, of whom 152 (54.7%) received NAIC. NAIC plus surgery was associated with better disease-free survival (DFS) and overall survival (OS) than surgery alone, including among patients aged >75 years. The perioperative outcomes and incidence rates of postoperative complications were similar between the two groups. Patients aged >75 years showed no increase in grade 3 or higher NAIC-related adverse events and no reduction in pathological tumor regression grade. In addition, multivariable analysis highlighted adjuvant therapy as a favorable factor for OS; however, in patients who received NAIC, major pathological response was independently associated with both DFS and OS, regardless of whether adjuvant therapy was received. This study revealed that NAIC plus surgery is a safe and clinically effective treatment that improves survival in elderly patients with locally advanced resectable ESCC, including in carefully selected fit patients aged >75 years.