Cancer Biology & Therapy (Dec 2025)
Definitive chemoradiotherapy combined with anti-PD-1 immunotherapy for inoperable esophageal squamous cell carcinoma: a multicenter real-world study
Abstract
The potential benefits of adding immune checkpoint inhibitors (ICIs) to definitive chemoradiotherapy (dCRT) for inoperable esophageal squamous cell carcinoma (ESCC) remain unclear, different timing for immunotherapy intervention during the peri-dCRT period on survival outcomes is worth exploring. Patients with inoperable ESCC receiving dCRT combined with ICIs between April 2018 and April 2022 were recruited from five hospitals in China. A historical control group treated with dCRT alone was used for comparison. Stabilized inverse probability of treatment weights (sIPTW) analyses were conducted to compare survival. The survival outcomes and treatment-related adverse effects were analyzed. A total of 290 patients with inoperable ESCC who received dCRT+ICI treatment were analyzed. The median follow-up was 35.7 months. The 1-year and 2-year overall survival (OS) rates were 86.7% and 66.9%, respectively, and the 1-year and 2-year progression-free survival (PFS) rates were 66.7% and 47.3%, respectively. The median PFS was 22.4 months, and the median OS was not reached. The dCRT+ICI group had significantly longer OS than the historical control group (2-year OS: 66.9% vs. 56.5%, for sIPTW-adjusted data: HR = 0.62, p < .001). After sIPTW, no differences in OS were found among the induction, concurrent, and consolidation groups. The sIPTW-adjusted analysis showed that both the induction and concurrent groups had significantly longer PFS than the consolidation group. Combining immunotherapy with dCRT improved survival outcomes and demonstrated a favorable safety profile in patients with inoperable ESCC. Induction or concurrent immunotherapy may provide superior survival benefits compared to consolidation immunotherapy.Trial registration Trial no. NCT04821778 registered in ClinicalTrials.gov
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