PD09.02. Nutritional Vulnerability Predicts Treatment Delivery and Survival in Locally Advanced Esophageal Squamous Cell Carcinoma Undergoing Neoadjuvant Immunochemotherapy

Abstract

Esophageal Cancer: Other Malnutrition is highly prevalent in esophageal squamous cell carcinoma (ESCC) and may critically modulate host resilience to intensive multimodal therapy. In the era of neoadjuvant immunochemotherapy (nICT), the prognostic utility of structured nutritional assessment remains incompletely defined. This study aimed to establish clinically relevant Patient-Generated Subjective Global Assessment (PG-SGA) thresholds and to determine their associations with treatment feasibility and oncologic outcomes. This multicenter retrospective cohort included 498 patients with potentially resectable locally advanced ESCC treated with 2–4 cycles of platinum–taxane chemotherapy combined with a programmed cell death-1 inhibitor, followed by planned esophagectomy. Optimal PG-SGA cut points were derived using classification and regression tree analysis to stratify nutritional risk. Associations between nutritional strata and neoadjuvant treatment completion, severe toxicities, postoperative morbidity, overall survival (OS), and disease-free survival (DFS) were evaluated. Multivariable Cox regression models adjusted for clinicopathologic characteristics and pathological response. PG-SGA scores were categorized into low (≤10; n = 309), intermediate (11–12; n = 90), and high (>12; n = 99) nutritional risk groups. A graded decline in surgical completion was observed across strata (97.1%, 93.3%, and 76.7%, respectively; P < 0.001), accompanied by a stepwise increase in grade ≥3 treatment-related toxicities (21.0%, 36.7%, and 51.5%; P < 0.001). Rates of postoperative pneumonia and intensive care unit utilization similarly rose with worsening nutritional status. Survival outcomes demonstrated a clear gradient: 2-/3-year OS rates were 82.7%/76.4% in the low-risk group, 75.6%/66.7% in the intermediate-risk group, and 59.5%/43.2% in the high-risk group (P < 0.001). Among patients who underwent resection, inferior survival persisted in the high-risk category. After multivariable adjustment, PG-SGA >12 independently predicted poorer OS (hazard ratio 2.03) and DFS (hazard ratio 1.75). Notably, in patients with high nutritional risk, receipt of postoperative immunotherapy was associated with significant improvement in 2-/3-year OS. A PG-SGA score >12 delineates a nutritionally vulnerable ESCC subgroup characterized by compromised treatment completion, heightened perioperative morbidity, and inferior survival following nICT. Incorporating standardized nutritional risk stratification into routine care may facilitate early supportive interventions and inform individualized postoperative therapeutic decision-making.