For Advanced Oesophageal Squamous Cell Carcinoma, PD-1 Antibody Combined with Chemotherapy Improves Progression-Free Survival Compared with Monotherapy or Chemotherapy Alone as First-Line Treatment: A Retrospective Study with Prognostic Biomarker Analysis.

BACKGROUND: Oesophageal squamous cell carcinoma (OSCC) accounts for >90% of oesophageal cancer cases in China, with most patients diagnosed at an advanced stage and poor prognosis. Real-world comparative data on first-line chemotherapy, PD-1 monotherapy, and their combination remain limited. OBJECTIVE: To evaluate the efficacy and safety of first-line camrelizumab plus nab-paclitaxel and cisplatin versus PD-1 monotherapy or chemotherapy alone in advanced OSCC, and to identify prognostic peripheral blood biomarkers. METHODS: Retrospective analysis of 253 patients (combination, n=68; PD-1 monotherapy, n=77; chemotherapy alone, n=108). Progression-free survival (PFS) was compared by Log rank test; objective response rate (ORR) and disease control rate (DCR) by chi-square; independent prognostic factors by Cox regression. RESULTS: ORR/DCR did not differ significantly among groups (P>0.05). Adverse events included vomiting, cytopenias, and fatigue; grade 1-2 anaemia was higher in combination vs monotherapy (76.5% vs 29.9%, P<0.001), and neutropenia higher in combination vs chemotherapy alone (72.1% vs 49.1%, P=0.002). Median overall survival was longest in the combination group (12.0 months) versus monotherapy (6.0 months) and chemotherapy alone (9.0 months). PFS differed significantly across all groups (all P<0.001). Poorly differentiated tumours, elevated NLR (≥5), and higher BMI were independent prognostic factors. CONCLUSION: First-line camrelizumab-based combination significantly improves PFS with manageable toxicity; NLR is a readily available independent biomarker, supporting this regimen as a preferred option and aiding patient selection in clinical practice.