Neoadjuvant chemotherapy with or without PD-1/PD-L1 inhibitors in resectable esophageal squamous cell carcinoma: a meta-analysis based on randomized controlled trials

作者：Ye Zhang, Jie Chen, Fenglian Yu, Wenxiong Zhang, Yingmei Zhong · 发表于：BMC Gastroenterology · 年份：2025 · DOI：10.1186/s12876-025-04030-7 · 被引用次数：7 · 研究领域：Esophageal Cancer Research and Treatment、Cancer Immunotherapy and Biomarkers、Colorectal and Anal Carcinomas

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...