Landmark phase 3 trials such as KEYNOTE-590 (pembrolizumab plus chemotherapy), CheckMate-648 (nivolumab plus chemotherapy or nivolumab plus ipilimumab), and RATIONALE-306 (tislelizumab plus chemotherapy) have established the superiority of PD-1 inhibitor-based combinations over chemotherapy alone in the first-line treatment of advanced ESCC, leading to their widespread adoption in clinical practice (9–11). This evidence concerns the gene PDCD1 and esophageal squamous cell carcinoma.