P1.155. Impact of Lymphaticvessel Invasion on Prognosis in Patients With Esophageal Squamous Cell Carcinoma Undergoing Neoadjuvant Immunochemotherapy: A Multicenter Retrospective Study

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer Prognostic stratification remains inadequate in patients with locally advanced esophageal squamous cell carcinoma (ESCC) following neoadjuvant immunotherapy combined with chemotherapy (NICT). This multicenter study aimed to determine the prognostic value of lymph node status (ypN+) and lymphovascular invasion (LVI) in this patient population after treatment. We retrospectively analyzed data from 439 ESCC patients who underwent NICT followed by esophagectomy at seven high-volume centers in China (2019-2021). Overall survival (OS) was compared according to ypN status, LVI status, and the extent of lymph node dissection. Independent prognostic factors were identified using Cox regression models. With a median follow-up of 30 months, the 4-year OS and disease-free survival (DFS) rates were 67% and 52%, respectively. Multivariate analysis established ypN+ (P < 0.001) and LVI positivity (P = 0.044) as independent predictors of poorer OS. ypN+ was also an independent factor for reduced DFS (P < 0.001). Subgroup analysis demonstrated a pronounced survival gradient: the LVI (-) ypN0 group had the best 4-year OS (87%), the LVI (+) ypN+ group had the worst (35%), while groups with either LVI (+) or ypN+ had intermediate and comparable outcomes (72% vs. 70%). Furthermore, dissection of more than 15 lymph nodes was associated with significantly improved survival. The combination of LVI and ypN status serves as a powerful prognostic tool for risk stratification in ESCC patients after NICT and surgery, potentially guiding adjuvant therapy decisions. To ensure both accurate staging and optimal survival outcomes, a lymph node dissection count exceeding 15 is recommended.