A retrospective pilot study of neoadjuvant chemotherapy combined with immunotherapy in the treatment of thoracic esophageal squamous cell carcinoma with cervical lymph node metastasis.

e16000 Background: Esophageal squamous cell carcinoma (ESCC) with cervical lymph node metastasis (CLNM) has a poor prognosis. Guidelines recommend chemotherapy combined with immunotherapy (CIT), showing 26-45% 1-year progression-free survival, with local recurrence rates reaching 40%. Neoadjuvant CIT shows increasing efficacy and safety for ESCC. Patients with CLNM have better survival than those with other distant metastases and may benefit from surgery. Adding surgery to CIT could improve outcomes. This retrospective pilot study may offer clinical insights. Methods: From January 2023 to December 2024, 20 patients were pathologically confirmed of both ESCC and CLNM before initial therapy in our center and no other distant metastasis was indicated. They subsequently underwent neoadjuvant CIT, and received McKeown esophagectomy with three-field lymph node dissection. We retrospectively collected the response, survival and adverse events data from these patients. Results: The characteristics of the 20 patients were shown in the table. All received 3-4 cycles of neoadjuvant CIT except for one who underwent surgery after the second cycle due to cutaneous adverse reactions. 19 patients received camrelizumab, nab-paclitaxel, and S-1 regimen and 1 received tislelizumab, nab-paclitaxel and nedaplatin regimen. After neoadjuvant treatment, 90.0% (18/20) patients had cervical lymph nodes turned negative, with a median of 17 [interquartile range (IQR), 12-34] dissected cervical lymph nodes. The pathological complete response (pCR) for esophageal lesions was 40.0% (8/20), and the total pCR rate was 35.0% (7/20). The median postoperative stay was 15 days (IQR, 13-29.5). With a median follow-up of 8.2 months, the cohort exhibited a 1-year disease-free survival rate of 80%. One patient had recurrence at postoperative day 317. No death happened in the follow-up. Safety data showed no grade ≥3 treatment-related adverse events. The most common adverse event was anemia (40%). Postoperative complications included pneumonia (35%), recurrent nerve paralysis (15%), and anastomotic leak (10%), and no Clavien-Dindo grade ≥4 complications occurred. Conclusions: With manageable safety profiles, high pathological response rates and enhanced survival rates, neoadjuvant CIT shows significant potential for improving clinical outcomes in ESCC and CLNM. Further prospective trials are needed to fully evaluate the effectiveness and safety of this treatment strategy for these patients. Baseline characteristics of the patients. Characteristic Case No. (%) Clinical T staging ≥ 3 16 (80%) Clinical N staging ≥ 2 14 (14%) Baseline level VI CLNM 12 (60%) Baseline level V CLNM 1 (5%) Baseline level IV CLNM 15 (75%) Bilateral CLNM 5 (20%) Baseline CLNM amount (ultrasound indicated) 1 5 (25%) >1 15 (75%)