本研究比较了初始不可切除的食管鳞状细胞癌 (iuESCC) 患者的诱导化疗 (iC) 和诱导免疫化疗 (iIC) 的手术转化率和总生存率 (OS)。 在这项多中心、回顾性队列研究中，来自四个高危人群的患者- 包括患有不可切除疾病的大量机构。主要终点是转换手术率和 OS。使用多变量 Cox 回归分析来确定与 OS 相关的独立显着预后因素。应用稳定的治疗权重逆概率来确认 iIC 和 iC 队列之间的生存比较。总共纳入 309 名患者（iIC 队列中 150 名，iC 队列中 159 名）。在 iIC 队列中观察到显着更高的转换手术率（iIC 与 iC：127/150、84.7% vs. 79/159、49.7%，P < 0.001）。 iIC 和 iC 队列的病理完全缓解率分别为 22.0% 和 5.1%（P = 0.001）。在 iIC（未达到）和 iC 队列之间观察到 OS 存在显着差异（中位 95% CI 36.3 [范围 27.2-45.5]）。治疗加权的稳定逆概率产生了类似的结果。治疗方案（iIC 与 iC，HR 0.215，95% CI 0.102-0.454，​​P < 0.001）和手术（是与否，HR 0.262，95% CI 0.161-0.427，P < 0.001）是 OS 的重要预后因素.诱导环境中的免疫化疗加转化手术可能是一种更好的治疗选择，可实现 iuESCC 患者的高病理反应并改善 OS。© 2024。外科肿瘤学会。

This study compared the surgical conversion rate and overall survival (OS) between induction chemotherapy (iC) and induction immunochemotherapy (iIC) for patients with initially unresectable esophageal squamous cell carcinoma (iuESCC).In this multicenter, retrospective cohort study, patients from four high-volume institutions with unresectable diseases were included. The primary endpoints were the conversion surgery rate and OS. A multivariate Cox regression analysis was used to identify the independent significant prognostic factors associated with OS. The stabilized inverse probability of treatment weighting was applied to confirm the survival comparison between the iIC and iC cohorts.A total of 309 patients (150 in the iIC cohort and 159 in the iC cohort) were included. A significantly higher conversion surgical rate was observed in the iIC cohort (iIC vs. iC: 127/150, 84.7% vs. 79/159, 49.7%, P < 0.001). The pathological complete response rates were 22.0% and 5.1% in the iIC and the iC cohorts, respectively (P = 0.001). A significant difference in the OS was observed between the iIC (not reached) and iC cohorts (median 95% CI 36.3 [range 27.2-45.5]). The stabilized inverse probability of treatment weighting yielded similar results. Regimen (iIC vs. iC, HR 0.215, 95% CI 0.102-0.454, P < 0.001) and operation (yes vs. no, HR 0.262, 95% CI 0.161-0.427, P < 0.001) were the significant prognostic factors for OS.Immunochemotherapy plus conversion surgery in the induction setting may be a better treatment option to achieve high pathological responses and improve OS in iuESCC patients.© 2024. Society of Surgical Oncology.