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Backgrounds <p>While adjuvant immunotherapy (AIT) is recommended for non-pathological complete response (non-pCR) patients, its role in ypStage I esophageal cancer (EC) patients with low tumor burden remains unclear. The study aims to evaluate the necessity of AIT for esophageal cancer patients achieving ypStage I following neoadjuvant immunochemotherapy (NICT) and surgery.</p> Methods <p>This retrospective study analyzed 157 ypStage I (ypT0-2N0M0) EC patients treated with NICT followed by surgery in Sun Yat-sen University Cancer Center between 2019 and 2024. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) adjusted for baseline imbalances between the none adjuvant therapy (NAT, n = 121)&#xa0; group and&#xa0;AIT (n = 36) group. Survival outcomes&#xa0;analyses and Cox regression analyses were performed.</p> Results <p>In the&#xa0;unmatched cohorts, 3-year overall survival (3-y OS) was 93.53% (NAT) versus 87.68% (AIT) (<i>p</i> = 0.76), and 3-year disease-free survival (3-y DFS) was 86.38% versus 84.17% (<i>p</i> = 0.60). Post-PSM (OS: 91.95% vs. 87.68%, <i>p</i> = 0.81 and DFS: 88.58% vs. 84.17%, <i>p</i> = 0.45) and IPTW-adjusted analyses (OS: 93.74% vs. 87.76%, <i>p</i> = 0.76 and DFS: 87.96% vs. 79.08%, <i>p</i> = 0.60) confirmed no survival advantage for AIT. Cox regression revealed no significant prognostic value of AIT for OS (unmatched cohorts: HR = 1.29, <i>p</i> = 0.757; PSM: HR = 1.270, <i>p</i> = 0.810; and IPTW: HR = 1.760, <i>p</i> = 0.536) or DFS (unmatched cohorts: HR = 1.320, <i>p</i> = 0.597; PSM: HR = 1.720, <i>p</i> = 0.459; and IPTW: HR = 2.230, <i>p</i> = 0.207).</p> Conclusions <p>Patients with ypStage I EC following NICT and surgery might not benefit from AIT. This study provides a hint for the risk–benefit balance of prolonged immunotherapy exposure in ypStage I patients while preserving clinical efficacy. Further studies are warranted.</p>

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Adjuvant immunotherapy fails to improve survival in ypStage I esophageal cancer after neoadjuvant immunochemotherapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月13日

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  • Yan Huang,
  • Fan Dong,
  • Caiyan Fang,
  • Jiadi Wu,
  • Zhichao Li,
  • Jiyang Chen,
  • Xiuying Xie,
  • Hong Yang,
  • Kongjia Luo,
  • Jianhua Fu

摘要

Backgrounds

While adjuvant immunotherapy (AIT) is recommended for non-pathological complete response (non-pCR) patients, its role in ypStage I esophageal cancer (EC) patients with low tumor burden remains unclear. The study aims to evaluate the necessity of AIT for esophageal cancer patients achieving ypStage I following neoadjuvant immunochemotherapy (NICT) and surgery.

Methods

This retrospective study analyzed 157 ypStage I (ypT0-2N0M0) EC patients treated with NICT followed by surgery in Sun Yat-sen University Cancer Center between 2019 and 2024. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) adjusted for baseline imbalances between the none adjuvant therapy (NAT, n = 121)  group and AIT (n = 36) group. Survival outcomes analyses and Cox regression analyses were performed.

Results

In the unmatched cohorts, 3-year overall survival (3-y OS) was 93.53% (NAT) versus 87.68% (AIT) (p = 0.76), and 3-year disease-free survival (3-y DFS) was 86.38% versus 84.17% (p = 0.60). Post-PSM (OS: 91.95% vs. 87.68%, p = 0.81 and DFS: 88.58% vs. 84.17%, p = 0.45) and IPTW-adjusted analyses (OS: 93.74% vs. 87.76%, p = 0.76 and DFS: 87.96% vs. 79.08%, p = 0.60) confirmed no survival advantage for AIT. Cox regression revealed no significant prognostic value of AIT for OS (unmatched cohorts: HR = 1.29, p = 0.757; PSM: HR = 1.270, p = 0.810; and IPTW: HR = 1.760, p = 0.536) or DFS (unmatched cohorts: HR = 1.320, p = 0.597; PSM: HR = 1.720, p = 0.459; and IPTW: HR = 2.230, p = 0.207).

Conclusions

Patients with ypStage I EC following NICT and surgery might not benefit from AIT. This study provides a hint for the risk–benefit balance of prolonged immunotherapy exposure in ypStage I patients while preserving clinical efficacy. Further studies are warranted.