To compare the efficacy and safety of sequential versus concurrent neoadjuvant immunochemotherapy in patients with locally advanced esophageal squamous cell carcinoma (ESCC), focusing on primary endpoints of pathological complete remission (pCR) and safety profiles.
Key Findings:
Overall pathological complete remission (pCR) rate was 22.2% with no significant difference between sequential (17.8%) and concurrent (26.9%) groups (P = 0.636).
Grade 3–5 treatment-related adverse events (TRAEs) occurred in 14.2% of patients, with higher rates of nausea and diarrhea in the concurrent group (P<0.05).
No significant differences in overall survival (OS) (P = 0.780) or disease-free survival (DFS) (P = 0.632) between the two treatment groups, with 6 treatment-related fatalities (5 in concurrent, 1 in sequential).
Interpretation:
The study indicates that both sequential and concurrent neoadjuvant immunochemotherapy regimens yield similar pCR and survival outcomes, but the concurrent regimen is associated with increased adverse effects, raising concerns for clinical application.
Limitations:
Small sample size may limit the generalizability of the findings.
Short follow-up duration may not capture long-term outcomes, potentially affecting the assessment of survival rates.
Conclusion:
There is no significant difference in pCR or survival outcomes between sequential and concurrent immunochemotherapy, although the concurrent approach presents higher risks of adverse events, including treatment-related fatalities.
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