Effective surgical conversion after neoadjuvant immunochemotherapy improves clinical outcomes in borderline resectable esophageal cancer

Background : Immune checkpoint inhibitors have demonstrated preliminary safety and efficacy in treating borderline resectable esophageal squamous cell carcinoma (BR-ESCC). We aimed to compare treatment and survival outcomes between patients with locally advanced resectable ESCC (cT3r) and those with borderline resectable ESCC (cT3br) who underwent surgery following neoadjuvant immunochemotherapy (NICT). Methods : After NICT, 12 patients in the cT3br group were deemed unresectable, while 102 patients with clinically staged T3 ESCC underwent surgery and were included in the study. Patients were categorized into cT3r and cT3br groups based on the likelihood of adjacent vital organ invasion as observed on pre-treatment CT scans. Results : Among the participants, 52 patients were included in the cT3br group and 62 in the cT3r group. The surgical conversion rate for cT3br tumors was 76.9% (40/52). Both groups exhibited comparable outcomes in terms of surgical treatment and postoperative complications ( P > 0.05). Although the non-R0 resection rate was significantly higher in the cT3br group than in the cT3r group (20.0% vs 3.2%, P = 0.005), no significant differences were observed in postoperative overall survival (OS) or disease-free survival (DFS) between the two groups (3-year OS: 76% vs 67%, P = 0.453; 3-year DFS: 69% vs 47%, P = 0.155). Non-R0 resection was significantly associated with worse OS ( P = 0.001) and showed a trend toward association with DFS ( P = 0.069). Conclusion : Surgery following NICT is an effective treatment strategy for BR-ESCC, achieving treatment outcomes and survival prognoses comparable to those in patients with cT3r.