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Adjuvant immunotherapy fails to improve survival in ypStage I esophageal cancer after neoadjuvant immunochemotherapy
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Adjuvant immunotherapy fails to improve survival in ypStage I esophageal cancer after neoadjuvant immunochemotherapy
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Journal Article
Adjuvant immunotherapy fails to improve survival in ypStage I esophageal cancer after neoadjuvant immunochemotherapy
2025
Overview
Backgrounds
While adjuvant immunotherapy (AIT) is recommended for non-pathological complete response (non-pCR) patients, its role in ypStage I esophageal cancer (EC) patients with low tumor burden remains unclear. The study aims to evaluate the necessity of AIT for esophageal cancer patients achieving ypStage I following neoadjuvant immunochemotherapy (NICT) and surgery.
Methods
This retrospective study analyzed 157 ypStage I (ypT0-2N0M0) EC patients treated with NICT followed by surgery in Sun Yat-sen University Cancer Center between 2019 and 2024. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) adjusted for baseline imbalances between the none adjuvant therapy (NAT, n = 121) group and AIT (n = 36) group. Survival outcomes analyses and Cox regression analyses were performed.
Results
In the unmatched cohorts, 3-year overall survival (3-y OS) was 93.53% (NAT) versus 87.68% (AIT) (
p
= 0.76), and 3-year disease-free survival (3-y DFS) was 86.38% versus 84.17% (
p
= 0.60). Post-PSM (OS: 91.95% vs. 87.68%,
p
= 0.81 and DFS: 88.58% vs. 84.17%,
p
= 0.45) and IPTW-adjusted analyses (OS: 93.74% vs. 87.76%,
p
= 0.76 and DFS: 87.96% vs. 79.08%,
p
= 0.60) confirmed no survival advantage for AIT. Cox regression revealed no significant prognostic value of AIT for OS (unmatched cohorts: HR = 1.29,
p
= 0.757; PSM: HR = 1.270,
p
= 0.810; and IPTW: HR = 1.760,
p
= 0.536) or DFS (unmatched cohorts: HR = 1.320,
p
= 0.597; PSM: HR = 1.720,
p
= 0.459; and IPTW: HR = 2.230,
p
= 0.207).
Conclusions
Patients with ypStage I EC following NICT and surgery might not benefit from AIT. This study provides a hint for the risk–benefit balance of prolonged immunotherapy exposure in ypStage I patients while preserving clinical efficacy. Further studies are warranted.
Publisher
Springer Berlin Heidelberg,Springer Nature B.V,Springer
