Neoadjuvant camrelizumab in combination with chemotherapy followed by sequential radical surgery for locally advanced esophageal squamous cell carcinoma: postoperative pathological remission characteristics and influencing factors.

Neoadjuvant camrelizumab combined with chemotherapy has shown favorable efficacy and safety profiles in the treatment of locally advanced esophageal squamous cell carcinoma (LA-ESCC). This study focused on the clinical data of patients treated with camrelizumab plus chemotherapy before and after neoadjuvant treatment, with the aims of exploring predictive markers for pathological response after radical resection, systematically verifying the safety of this regimen, and investigating indicators associated with long-term prognosis of patients. A retrospective analysis was conducted on patients with histologically confirmed LA-ESCC who were treated at the First Affiliated Hospital of Zhengzhou University between November 2019 and September 2024. Peripheral blood inflammatory and nutritional parameters, adverse events, and perioperative surgical outcomes were collected and recorded before and after neoadjuvant therapy. Disease-free survival (DFS) and overall survival (OS) were used as long-term endpoints to evaluate the impact of pathological response on patient prognosis. A total of 115 patients with LA-ESCC who underwent radical surgery after neoadjuvant camrelizumab combined with chemotherapy were finally included. Among them, 106 patients (92.2%) experienced treatment-related adverse events, of which only 16 cases were grade 3 or higher. Major pathological response (MPR) was achieved in 82 patients, with an MPR rate of 71.3%. The median follow-up duration was 43 months. Neither median overall survival (mOS) nor median disease-free survival (mDFS) was reached in the MPR group, while mOS and mDFS in the non-major pathological response (NMPR) group were 48 months and 41 months, respectively, indicating a significantly better prognosis in the MPR group than the NMPR group. The neutrophil-to-lymphocyte ratio (NLR) after neoadjuvant therapy was significantly different between patients with different pathological responses (P < 0.05). For patients with LA-ESCC, neoadjuvant camrelizumab combined with chemotherapy followed by radical surgery can significantly improve the rate of complete pathological response (CPR) and MPR, with a favorable overall safety profile. This study further confirms that lower NLR after neoadjuvant therapy is associated with better postoperative pathological remission, suggesting that NLR may serve as a convenient and readily available biomarker for predicting the efficacy of neoadjuvant immunochemotherapy in LA-ESCC.