{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:04:56Z","timestamp":1785305096108,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare efficacy, survival and tumor immune microenvironment between neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant immunochemotherapy (NICT) in patients with esophageal squamous cell carcinoma (ESCC) to guide individualized treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 346 locally advanced ESCC patients after 1:1 propensity score matching were retrospectively analyzed. Pathological, radiological and multiplex immunofluorescence assessments were performed, and survival outcomes were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>NCRT resulted in significantly greater tumor volume reduction (22.09 vs. 15.37 mm\u00b3), lower residual primary tumor ratio (14.10% vs. 32.23%), higher tumor downstaging and pathological complete response (pCR) rates (all p &amp;lt; 0.05). NCRT showed more prominent lymph node regression adjacent to the primary tumor than in peripheral nodes. Overall survival (OS) and recurrence-free survival (RFS) were comparable between groups. Among pCR patients, NICT achieved significantly better OS (p = 0.0051) and RFS (p = 0.018), while NCRT was associated with superior RFS in non-pCR patients (p = 0.0099). In the NICT group, high PD-L1 expression and low tumor burden tended to correlate with pCR. Immune microenvironment analysis revealed fewer immunosuppressive T cells and immune-evasive tumor cells in the NICT group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>NCRT presents superior local tumor regression, while NICT benefits pCR patients by optimizing the immune microenvironment. High PD-L1 expression and low tumor burden favor NICT. These findings support individualized neoadjuvant strategy selection for ESCC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1862815","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:57:43Z","timestamp":1785304663000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Neoadjuvant chemoradiotherapy versus immunochemotherapy in esophageal squamous cell carcinoma: a propensity-matched analysis of response, survival, lymph node pattern, and immune microenvironment"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhou","family":"Yehan","sequence":"first","affiliation":[{"name":"Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, 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