PD07.04. Prognosis of Patients With Esophageal Squamous Cell Carcinoma Achieved Pathological Complete Regression After Neoadjuvant Immunochemotherapy

Abstract

Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Pathological complete response (pCR) is an important outcome following neoadjuvant immunochemotherapy for locally advanced esophageal squamous cell carcinoma (ESCC). However, the long-term prognosis and predictive factors for recurrence in patients who achieve pCR remain poorly characterized. This retrospective study analyzed 154 ESCC patients who achieved pCR after neoadjuvant platinum-based chemotherapy combined with immune checkpoint inhibitors, followed by esophagectomy at our center (Jan 2020–Jun 2025). Preoperative clinical staging and postoperative pathological assessment were standardized. The primary endpoints were 3-year disease-free survival (DFS) and overall survival (OS). Survival curves were generated using the Kaplan-Meier method with log-rank test for comparison. Prognostic factors were identified via Cox proportional hazards regression. After a median follow-up of 25 months, the 3-year DFS and OS rates were 72% and 88%, respectively. Multivariate analysis identified ≥3 treatment cycles (HR 6.598, 95% CI 1.640–26.549, P=0.008), treatment-to-surgery interval <5 weeks (HR 4.374, 95% CI 1.070–17.869, P=0.040), and BMI <23.9 kg/m2 (HR 5.083, 95% CI 1.052–24.566, P=0.043) as independent risk factors for reduced DFS; higher clinical T-stage also correlated (P=0.019). For OS, older age (HR 1.234 per year, 95% CI 1.074–1.417, P=0.003) and low BMI (HR 62.560, 95% CI 2.892–1353.481, P=0.008) were significant, with higher cT-stage showing probable association (P=0.029). Postoperative adjuvant therapy did not improve outcomes. Achieving pCR does not guarantee cure. Distinct risk profiles emerge: factors like extensive neoadjuvant cycles, short treatment-to-surgery interval, low BMI, and advanced cT stage primarily signal recurrence risk, while older age and low BMI independently predict worse overall survival. Critically, adjuvant therapy offered no survival benefit. These findings call for risk-stratified postoperative surveillance over routine adjuvant therapy in pCR patients.