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Purpose <p>Neoadjuvant chemo-immunotherapy increases pathological response rates in resectable oesophageal squamous cell carcinoma (ESCC), but the prognostic value of pathological complete response (pCR) and major pathological response (MPR), together with the optimal number of neoadjuvant cycles, remains uncertain.</p> Methods/patients <p>We performed a PRISMA-IPD–compliant systematic review and individual-patient-data (IPD) meta-analysis of studies published from 2018 to 30 April 2025. IPD were obtained from investigators or reconstructed from Kaplan–Meier curves. One-stage Cox models and random-effects pooling assessed associations of pCR and MPR with overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS), and compared two versus three–four neoadjuvant cycles. The protocol was registered in PROSPERO (CRD420251027590).</p> Results <p>Fourteen studies (<i>n</i>=2072) were included. pCR was associated with improved OS (HR 0.23, 95% CI 0.15–0.37) and DFS (HR 0.24, 95% CI 0.15–0.39), and with longer PFS (HR 0.20, 95% CI 0.05–0.84). MPR predicted superior OS (HR 0.32, 95% CI 0.17–0.60) and DFS (HR 0.38, 95% CI 0.25–0.57), with borderline significance for PFS (HR 0.49, 95% CI 0.23–1.03). In exploratory analyses, no clear survival difference was observed between two cycles and three-to-four neoadjuvant cycles.</p> Conclusions <p>In resectable ESCC treated with neoadjuvant chemo-immunotherapy, pCR and MPR are robust prognostic markers for OS and DFS, whereas the exploratory cycle-number analysis did not show a clear survival advantage for three-to-four cycles over two cycles.</p>

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Association of pathological response with long-term survival after neoadjuvant chemo-immunotherapy in resectable oesophageal squamous cell carcinoma: a systematic review and individual-patient-data meta-analysis

  • 期刊论文

  • 发表日期：

    2026年7月6日

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  • Ruiying Zhang,
  • Zhe Wang,
  • Lulu Guan,
  • Bingtong Yue,
  • Dao Xin,
  • Feng Wang

摘要

Purpose

Neoadjuvant chemo-immunotherapy increases pathological response rates in resectable oesophageal squamous cell carcinoma (ESCC), but the prognostic value of pathological complete response (pCR) and major pathological response (MPR), together with the optimal number of neoadjuvant cycles, remains uncertain.

Methods/patients

We performed a PRISMA-IPD–compliant systematic review and individual-patient-data (IPD) meta-analysis of studies published from 2018 to 30 April 2025. IPD were obtained from investigators or reconstructed from Kaplan–Meier curves. One-stage Cox models and random-effects pooling assessed associations of pCR and MPR with overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS), and compared two versus three–four neoadjuvant cycles. The protocol was registered in PROSPERO (CRD420251027590).

Results

Fourteen studies (n=2072) were included. pCR was associated with improved OS (HR 0.23, 95% CI 0.15–0.37) and DFS (HR 0.24, 95% CI 0.15–0.39), and with longer PFS (HR 0.20, 95% CI 0.05–0.84). MPR predicted superior OS (HR 0.32, 95% CI 0.17–0.60) and DFS (HR 0.38, 95% CI 0.25–0.57), with borderline significance for PFS (HR 0.49, 95% CI 0.23–1.03). In exploratory analyses, no clear survival difference was observed between two cycles and three-to-four neoadjuvant cycles.

Conclusions

In resectable ESCC treated with neoadjuvant chemo-immunotherapy, pCR and MPR are robust prognostic markers for OS and DFS, whereas the exploratory cycle-number analysis did not show a clear survival advantage for three-to-four cycles over two cycles.