Impact of immunotherapy combined with neoadjuvant chemotherapy or chemoradiotherapy on perioperative safety in locally advanced esophageal squamous cell carcinoma (LA-ESCC): A retrospective propensity score-matched analysis.
Authors: Li Yixin , Xiao Gang , Yang Bo , Hong Yidan , Gu Lingling , Kong Cheng , Zhao Lijun , Zhu Zihao , Xu Qicen , Chen Yu , Jiang Ming , Zhu Xiangzhi , Jiang Ning 
Published: July 2024

e16105

Background: Immunotherapy combined with chemotherapy (nICT) or chemoradiotherapy (nICRT) has become the latest option for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). The safety of this treatment remains uncertain. This study aims to evaluate the perioperative safety profile of nICT or nICRT among patients diagnosed with LA-ESCC. Methods: LA-ESCCpatients who underwent esophagectomy with or without neoadjuvant immunotherapy combining treatments (nIComT) at Jiangsu Cancer Hospital from January 2020 to January 2022 were included. A 1:1 propensity score matching (PSM) was used to balance demographic and oncologic characteristics between the two groups. The primary endpoint was postoperative complications, which were assessed by the Esophageal Cancer Complications Consensus Group (ECCG) criteria and the Clavien-Dindo criteria. Results: 1477 patients were screened, and a total of 873 patients were eligible for this study.Through PSM based on age, gender, body mass index, and clinical TNM stage, 118 pairs of patients were evenly allocated to the surgery-alone and nIComT groups. Compared to the surgery-alone group, the nIComT group showed slightly higher complication rates (66.1% vs 77.1%, P= 0.061). Grade Ⅰ or Ⅱ cardiovascular system complications appeared to be more common in the nIComT group than the surgery-alone group (57.6% vs 37.3%, P= 0.002). The cardiovascular system complications mainly included hypotension with sinus tachycardia (53.4% vs 34.7%, P= 0.004) which requires continuous pumping of vasopressor medications including dopamine, ephedrine, and norepinephrine during the perioperative period. It is noteworthy that patients in the nIComT group exhibited a higher incidence of perioperative diuretic and cardiotonic therapy due to congestive heart failure compared to the surgery-alone group (11.0% vs 5.1%, P= 0.094), although this disparity did not attain statistical significance. The nIComT group exhibited a notable increase in the percentage of patients requiring perioperative blood transfusion (35.6% vs 16.9%, P= 0.001), as well as an extended operation duration (277 ± 66 vs 246 ± 62 mins, P< 0.001), when compared to the surgery-alone group. Additionally, there was also a trend towards a higher proportion of patients in the nIComT group requiring intraoperative blood transfusion due to excessive blood loss (7.6% vs 2.5%, P= 0.075). The surgery-alone group ( n= 1) and the nIComT group ( n= 3) showed no significant differences in 30-day mortality rates ( P= 0.614). Conclusions: Our findings revealed a heightened incidence of cardiovascular complications among patients received nIComT, underscoring the significance of perioperative circulatory interventions. Further prospective studies are needed for validation.