Induction immunochemotherapy followed by concurrent chemoradiotherapy improves survival in unresectable esophageal cancer: a systematic review, meta-analysis, and network meta-analysis

作者：Fan X, Liu X, Mi S, Yang Y, Li C, Zhang J, Hu P · 发表于：Frontiers in immunology · 年份：2026 · DOI：10.3389/fimmu.2026.1767380 · 被引用次数：101 · 研究领域：Esophageal Neoplasms、Chemoradiotherapy、Immunotherapy、Humans、Treatment Outcome

BACKGROUND: Concurrent chemoradiotherapy (CCRT) remains the standard treatment for unresectable esophageal cancer (EC). However, the clinical benefits of combining immunotherapy with CCRT for unresectable EC remain controversial. Therefore, we conducted a systematic review and meta-analysis to evaluate the potential benefits of different immunotherapy strategies added to CCRT in patients with unresectable EC. METHODS: We employed single-arm, pairwise and network meta-analysis (NMA) methods to analyze the overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and safety of several combined treatment strategies based on CCRT. RESULTS: 30 single-arm trials and 39 controlled trials involving a total of 9648 participants were included. Compared with CCRT alone, both induction immunochemotherapy plus CCRT (ICT-CCRT) and CCRT plus consolidation immunotherapy (CCRT-IO) significantly improved OS in pairwise meta-analyses (HR 0.52, 95% CI 0.39-0.71, I²= 0.0%; HR 0.77, 95% CI 0.65-0.90, I²= 0.0%, respectively). In the NMA, only ICT-CCRT showed a significant OS benefit (HR 0.75, 95% CI 0.64-0.88), whereas CCRT-IO did not. For PFS, CCRT-IO consistently prolonged PFS compared with CCRT alone in both pairwise meta-analyses (HR 0.74, 95% CI 0.64-0.85, I²=0.0%) and NMA (HR 0.78, 95% CI 0.76-0.99). In contrast, ICT-CCRT demonstrated a significant PFS benefit only in the NMA (HR 0.84, 95% CI 0.71-0.99), but not in the pairwise analysis. Notably, ICT-CCRT ranked ...