Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trials
Abstract Background Neoadjuvant chemotherapy (NC) is a cornerstone in the management of resectable esophageal squamous cell carcinoma (ESCC). The integration of PD-1/PD-L1 inhibitors into NC (NIC) regimens has shown promise; however, its efficacy and safety remain uncertain. This meta-analysis aims...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12876-025-04030-7 |
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| author | Ye Zhang Jie Chen Fenglian Yu Wenxiong Zhang Yingmei Zhong |
| author_facet | Ye Zhang Jie Chen Fenglian Yu Wenxiong Zhang Yingmei Zhong |
| author_sort | Ye Zhang |
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| description | Abstract Background Neoadjuvant chemotherapy (NC) is a cornerstone in the management of resectable esophageal squamous cell carcinoma (ESCC). The integration of PD-1/PD-L1 inhibitors into NC (NIC) regimens has shown promise; however, its efficacy and safety remain uncertain. This meta-analysis aims to compare the potential risks and clinical benefits of NIC versus NC in patients with resectable ESCC based on randomized controlled trials (RCTs). Methods A thorough search of six databases was performed to identify RCTs evaluating NIC and NC in resectable ESCC. Key outcomes analyzed included the pathological complete response (pCR) rate and the major pathological response (MPR) rate. Other outcomes analyzed included overall survival (OS), event-free survival (EFS), surgery rate, R0 resection rate, and adverse events (AEs). Results Four RCTs encompassing 605 patients were included. NIC significantly improved pCR rate (risk ratio [RR]: 2.66 [1.63, 4.34], P < 0.0001) and MPR rate (RR: 1.74 [1.02, 2.95], P = 0.04) compared to the NC group. Only one phase III RCT reported survival outcomes, showing that the NIC group demonstrated improved OS (HR: 0.48 [0.24, 0.96], P = 0.04) and EFS (HR: 0.62 [0.39, 0.99], P = 0.05). Additionally, surgery rate (RR: 1.11 [1.03, 1.20], P = 0.008) and the number of resected lymph nodes (mean difference [MD]: 3.91 [0.60, 7.21], P = 0.02) were also higher in the NIC group. The R0 resection rate, duration of surgery, and intraoperative blood loss were comparable between the groups. However, the rate of immune-related AEs (irAEs) (RR: 40.80 [5.67, 293.37], P = 0.0002) was significantly higher in the NIC group. Similar surgical complications were observed between the two groups. Conclusions NIC demonstrates superior efficacy in improving pCR and MPR in resectable ESCC compared to NC alone, and may potentially provide survival benefits, although it is associated with a higher risk of irAEs. |
| format | Article |
| id | doaj-art-ae366fd651bc4cd686b434f6563fd161 |
| institution | OA Journals |
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| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj-art-ae366fd651bc4cd686b434f6563fd1612025-08-20T02:00:01ZengBMCBMC Gastroenterology1471-230X2025-05-0125111110.1186/s12876-025-04030-7Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trialsYe Zhang0Jie Chen1Fenglian Yu2Wenxiong Zhang3Yingmei Zhong4Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical CollegeDepartment of Thoracic Surgery, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical CollegeDepartment of Thoracic Surgery, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical CollegeDepartment of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Thoracic Surgery, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical CollegeAbstract Background Neoadjuvant chemotherapy (NC) is a cornerstone in the management of resectable esophageal squamous cell carcinoma (ESCC). The integration of PD-1/PD-L1 inhibitors into NC (NIC) regimens has shown promise; however, its efficacy and safety remain uncertain. This meta-analysis aims to compare the potential risks and clinical benefits of NIC versus NC in patients with resectable ESCC based on randomized controlled trials (RCTs). Methods A thorough search of six databases was performed to identify RCTs evaluating NIC and NC in resectable ESCC. Key outcomes analyzed included the pathological complete response (pCR) rate and the major pathological response (MPR) rate. Other outcomes analyzed included overall survival (OS), event-free survival (EFS), surgery rate, R0 resection rate, and adverse events (AEs). Results Four RCTs encompassing 605 patients were included. NIC significantly improved pCR rate (risk ratio [RR]: 2.66 [1.63, 4.34], P < 0.0001) and MPR rate (RR: 1.74 [1.02, 2.95], P = 0.04) compared to the NC group. Only one phase III RCT reported survival outcomes, showing that the NIC group demonstrated improved OS (HR: 0.48 [0.24, 0.96], P = 0.04) and EFS (HR: 0.62 [0.39, 0.99], P = 0.05). Additionally, surgery rate (RR: 1.11 [1.03, 1.20], P = 0.008) and the number of resected lymph nodes (mean difference [MD]: 3.91 [0.60, 7.21], P = 0.02) were also higher in the NIC group. The R0 resection rate, duration of surgery, and intraoperative blood loss were comparable between the groups. However, the rate of immune-related AEs (irAEs) (RR: 40.80 [5.67, 293.37], P = 0.0002) was significantly higher in the NIC group. Similar surgical complications were observed between the two groups. Conclusions NIC demonstrates superior efficacy in improving pCR and MPR in resectable ESCC compared to NC alone, and may potentially provide survival benefits, although it is associated with a higher risk of irAEs.https://doi.org/10.1186/s12876-025-04030-7NeoadjuvantPD-1/PD-L1 inhibitorsChemotherapyEsophageal squamous cell carcinomaMeta-analysisRandomized controlled trials |
| spellingShingle | Ye Zhang Jie Chen Fenglian Yu Wenxiong Zhang Yingmei Zhong Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trials BMC Gastroenterology Neoadjuvant PD-1/PD-L1 inhibitors Chemotherapy Esophageal squamous cell carcinoma Meta-analysis Randomized controlled trials |
| title | Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trials |
| title_full | Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trials |
| title_fullStr | Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trials |
| title_full_unstemmed | Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trials |
| title_short | Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trials |
| title_sort | neoadjuvant chemotherapy with or without pd 1 pd l1 inhibitors in resectable esophageal squamous cell carcinoma a meta analysis based on randomized controlled trials |
| topic | Neoadjuvant PD-1/PD-L1 inhibitors Chemotherapy Esophageal squamous cell carcinoma Meta-analysis Randomized controlled trials |
| url | https://doi.org/10.1186/s12876-025-04030-7 |
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