Pathological response and prognostic factors of neoadjuvant PD-1 blockade combined with chemotherapy in resectable oesophageal squamous cell carcinoma

• Published in: European journal of cancer (1990) 2023-06, Vol.186, p.196-210
• Main Authors: Wang, Honglei, Jiang, Zeying, Wang, Qihua, Wu, Tong, Guo, Fangzhou, Xu, Zhengyuan, Yang, Weixiong, Yang, Shicong, Feng, Shiting, Wang, Xiaoyan, Chen, Shuling, Cheng, Chao, Chen, Wenfang
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin - therapeutic use; Esophageal Neoplasms - pathology; Esophageal squamous cell carcinoma; Esophageal Squamous Cell Carcinoma - therapy; Humans; Neoadjuvant immunotherapy; Neoadjuvant Therapy; Neoplasm Staging; Paclitaxel; Pathological response; PD-1 inhibitor; Prognosis; Programmed Cell Death 1 Receptor - therapeutic use; Recurrence
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2023.03.008

We aimed to investigate the pathological changes, clinicopathological correlation and prognostic factors of neoadjuvant programmed cell death 1 (PD-1) blockade camrelizumab combined with carboplatin and nab-paclitaxel (CCNP) which we have proved its effectiveness in previous research for resectable esophageal squamous cell carcinoma (ESCC). 108 patients of resectable ESCC, with a mean follow-up of 13 m (ranging 1–30 m), treated with neoadjuvant CCNP from March 2020 to October 2022 in the First Affiliated Hospital of Sun Yat-sen University were enrolled. One year overall survival (OS) and disease-free survival (DFS) were 96.4% and 84.7% respectively. Pathological complete response or major pathological response (pCR/MPR) of the primary tumour (T-pCR/T-MPR) and the metastatic lymph node (N-pCR/N-MPR) were 58.3% and 47.5%. Pathological response of both primary tumours (PT) and lymph nodes (LN) metastasis correlated with DFS. LN pathological response was consistent with PT in 70.0% and inconsistent in 30.0% metastatic cases. Higher ratio of CD8+ to FoxP3+ tumour-infiltrating lymphocytes (TILs), earlier ypT stage and PT invasion not beyond circular muscle correlated with better pathological response. Four types of regression patterns of PT and two types of metastatic LN regression were found. A total of 18 (16.7%) out of 108 developed recurrence with a mean time of 6.9 ± 5.3 months. PT pathological response plus ypN and PT invasion beyond circular muscle or not were independent prognostic factors of DFS. This study suggested that camrelizumab plus chemotherapy had a high rate of T-pCR/T-MPR for resectable ESCC. T-pCR/T-MPR plus ypN0 and tumour invasion not beyond circular muscle predicted better DFS. •Neoadjuvant camrelizumab plus chemotherapy is effective for ESCC.•Pathological response of PT was inconsistent with metastatic LN in 30% cases.•Higher ratio of CD8+ to FoxP3+ TILs correlated with better pathological response.•Tumour regression patterns of both PT and metastatic LN were summarised.•PT pathological response and ypN and circular muscle penetration were independent prognostic factors.