Analysis of the short-term efficacy of 2 versus 3 cycles of neoadjuvant immunotherapy combined with chemotherapy in patients with esophageal squamous cell carcinoma

<b>Background:</b> Neoadjuvant immunotherapy combined with chemotherapy has a substantial impact on locally advanced esophageal squamous cell carcinoma (LA-ESCC), but the optimal number of treatment cycles is still controversial. <b>Method:</b> Patients who received 2 or 3 cycles of neoadjuvant immunotherapy combined with chemotherapy followed by esophagectomy to treat LA-ESCC were included. We compared the responses to neoadjuvant therapy, surgical outcomes, perioperative complications, and treatment-related adverse reactions in the two patient groups. <b>Results:</b> A total of 100 patients were included in the study. The pathologic complete response (pCR) rate in patients who received 2 cycles was 18/56 (32.14%), and the pCR rate in patients who received 3 cycles was 14/44 (31.82%) (P=0.97). There was no significant difference in the perioperative parameters, postoperative complications or treatment-related adverse reactions between the two groups (P>0.05). After the third cycle, some patients experienced further relief, with a significant decrease in the NLR (P=0.0.4). <b>Conclusion:</b> In LA-ESCC, the efficacy of both 2 cycles and 3 cycles of neoadjuvant immunotherapy combined with chemotherapy is comparable, with the same tolerance and feasibility. Further evaluation of the inflammation indicator NLR can help identify patients who would benefit from an additional third cycle of neoadjuvant therapy.