P1.138. Preoperative Systemic Inflammatory Burden as a Determinant of Long-Term Outcomes After Neoadjuvant Chemotherapy in Esophageal Squamous Cell Carcinoma

Abstract

Esophageal Cancer: Other Host-related systemic inflammation has emerged as a key modifier of tumor progression and therapeutic response across solid malignancies. However, its prognostic relevance in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemotherapy (NCT) followed by surgery remains insufficiently characterized. We aimed to evaluate whether an integrated preoperative inflammatory signature could refine survival stratification in this setting. In this multicenter retrospective cohort, 346 patients with locally advanced ESCC treated with NCT and subsequent curative resection were analyzed. A composite index reflecting systemic inflammatory status was derived from routine hematologic parameters using outcome-oriented cutoff values. Overall survival (OS) and disease-free survival (DFS) were assessed using multivariable Cox regression models. Propensity score matching (PSM) was performed to reduce baseline imbalances and validate the robustness of the findings. Predictive performance was further evaluated through discrimination and calibration analyses. After a median follow-up of 68 months, elevated preoperative inflammatory burden was significantly associated with inferior long-term outcomes. While individual inflammatory parameters demonstrated moderate prognostic value, the composite inflammatory signature provided improved discriminatory capacity, with a marked separation in 5-year OS (41.5% vs. 58.1%, P < 0.001). On multivariable analysis, high inflammatory burden independently predicted worse OS (HR 1.91, 95% CI 1.34–2.72; P < 0.001). These associations persisted after PSM, with significant effects observed for both OS (HR 2.05) and DFS (HR 1.82). An integrated prognostic model combining inflammatory burden with pathological nodal status and major pathological response achieved an area under the curve of 0.74, demonstrating favorable calibration and incremental prognostic value. Preoperative systemic inflammatory burden represents a readily accessible and clinically informative biomarker in ESCC patients undergoing NCT. When incorporated with established pathological factors, it enhances risk stratification and may inform individualized postoperative management strategies.