Objective To observe the short-term efficacy and safety of neoadjuvant sintilimab combined with chemotherapy in the treatment of patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC). MethodsClinical data were collected from patients with locally advanced resectable ESCC who received neoadjuvant immunotherapy combined with chemotherapy followed by surgical treatment at the Department of Thoracic Surgery of Jining First People's Hospital from April 2020 to April 2022. The endpoints included major pathological response (MPR), pathological complete response (pCR), R0 resection rate, safety, and postoperative survival. Results A total of 43 patients with ESCC who received at least one cycle of neoadjuvant immunotherapy before surgery were included. Among them, there were 31 males and 12 females, aged from 46 to 77 years, with a median age of 65 years. All patients successfully completed the surgery without any surgical delays. The pCR rate was 14.0% (6/43), the MPR rate was 58.1% (25/43), and the R0 resection rate was 97.7% (42/43). Patients exhibited reliable safety during neoadjuvant therapy and postoperatively. The 2-year overall survival and disease-free survival rates were 90.7% and 81.4%, respectively. Kaplan-Meier survival analysis and log-rank test revealed lower recurrence rates and better survival in the MPR group compared to the non-MPR group. Conclusion The combination of neoadjuvant sintilimab and chemotherapy in the treatment of patients with locally advanced resectable ESCC has demonstrated significant clinical efficacy, while also being safe and reliable.
ObjectiveTo explore the predictive value of the pre-treatment systemic immune-inflammation index (SII) for major pathological response (MPR) after neoadjuvant immunochemotherapy (nICT) in esophageal cancer, and to construct a clinical prediction model combined with relevant clinical characteristics. Methods Retrospective collection of clinical data from patients with locally advanced esophageal cancer who received nICT followed by radical surgery at the First People's Hospital of Jining from January 2022 to June 2023. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of pre-treatment SII and neutrophil-lymphocyte ratio (NLR) for the efficacy of nICT in esophageal cancer. The optimal cut-off value was determined based on the maximum Youden index. Further, univariate and multivariate logistic regression analyses were employed to identify predictors for MPR after nICT in esophageal cancer and to construct a nomogram model. The model was evaluated using the area under the ROC curve (AUC), and internal validation was conducted using the Bootstrap method. ResultsA total of 63 patients were included, with 38 males and 25 females, and a median age of 67 (49-79) years. The ROC curve indicated that the optimal cut-off value for pre-treatment SII was 521.7, with an AUC of 0.701 [95%CI (0.564, 0.838)] for predicting MPR after nICT in esophageal cancer. The ROC curve showed that the optimal cut-off value for pre-treatment NLR was 2.32, with an AUC of 0.681 [95%CI (0.544, 0.818)]. Multivariate logistic regression analysis results revealed cT stage [OR=0.232, 95%CI (0.071, 0.759), P=0.016] and SII [OR=5.477, 95%CI (1.584, 18.939), P<0.001] as independent predictors for MPR after nICT in esophageal cancer. Based on the multivariate logistic regression results, a clinical prediction model was constructed, with an AUC of 0.789 on the ROC curve. The calibration plot showed a good agreement between the prediction curve and the ideal curve. ConclusionPre-treatment SII can serve as an independent predictive indicator for MPR in patients with esophageal cancer after nICT. The clinical model, established in combination with cT stage, can better predict the efficacy of nICT in esophageal cancer.