新辅助放化疗（NCRT）被推荐作为局部晚期食管鳞状细胞癌（ESCC）的治疗标准。免疫疗法在新辅助治疗中的使用引起了人们的关注。多项临床试验探讨了新辅助免疫化疗（NICT）的有效性和安全性。我们评估了食管癌切除术前接受新辅助化疗 (NCT)、NCRT 和 NICT 的患者临床病理结果和淋巴管扩散模式的差异。总共纳入了 702 例在新辅助治疗后完成经胸食管切除术的食管鳞癌患者。评估病理学特征，包括病理完全缓解（pCR）、肿瘤消退等级（TRG）评分和淋巴扩散模式。与NCT组相比，NCRT组和NICT组在病理缓解方面具有优势（P < 0.05） 。 NCT组的pCR率为8.1%，NCRT组为29.9%，NICT组为23.6%。 NCT组TRG评分（P<0.05）和病理T分期（P<0.05）均显着升高。与NICT相比，NCRT可显着降低1R站（0 vs. 3.4%，P < 0.05）和2R站（1.1% vs. 6.8%，P < 0.05）淋巴结转移率。根据肿瘤部位分布进行亚组分析显示，NICT组中胸段2R站（9.1%）淋巴结转移率较高（P < 0.05），下胸段18站（7.5%）（P < 0.05）淋巴结转移率较高。 NCRT或NICT随后进行手术可能会带来良好的pCR率，并在原发灶的治疗反应中表现出更好的表现。对于 1R 和 2R 站淋巴结转移的患者，NCRT 应是最佳术前治疗策略。© 2023。外科肿瘤学会。

Neoadjuvant chemoradiotherapy (NCRT) is recommended as the treatment standard for locally advanced esophageal squamous cell carcinoma (ESCC). The use of immunotherapy in the neoadjuvant setting has gained attention. Multiple, clinical trials have explored the efficacy and safety of neoadjuvant immunochemotherapy (NICT). We evaluated the differences in clinicopathologic outcomes and the patterns of lymphatic spread among patients receiving neoadjuvant chemotherapy (NCT), NCRT, and NICT before esophagectomy for locally advanced ESCC.A total of 702 patients with ESCC who completed transthoracic esophagectomy followed neoadjuvant therapy were included. Pathological characteristics, including pathologic complete response (pCR), tumor regression grade (TRG) score and patterns of lymphatic spread, were evaluated.Compared with the NCT group, the NCRT group and NICT group had an advantage in pathological response (P < 0.05). The pCR rate was 8.1% in the NCT group, 29.9% in the NCRT group, and 23.6% in the NICT group. The TRG score (P < 0.05) and pathologic T stage (P < 0.05) in the NCT group were significantly higher. Compared with NICT, NCRT can significantly reduce the rate of lymph node metastasis rate in station 1R (0 vs. 3.4%, P < 0.05) and 2R (1.1% vs. 6.8%, P < 0.05). Subgroup analysis according to the tumor location distribution showed that NICT group had higher lymph node metastasis rate in station 2R (9.1%) in middle thoracic cases (P < 0.05) and in station 18 (7.5%) (P < 0.05) in lower thoracic cases.NCRT or NICT followed by surgery may result in a promising pCR rate and show a better performance in therapeutic response of primary lesion. For patients with lymph node metastasis in station 1R and 2R, NCRT should be the optimal preoperative treatment strategy.© 2023. Society of Surgical Oncology.