The prognostic power of major pathological response in esophageal squamous cell carcinoma patients undergoing...

For esophageal squamous cell carcinoma(ESCC), neoadjuvant chemoimmunotherapy (nICT) constitutes an innovative therapeutic strategy. However, The relationship between its short-term efficacy and long-term prognosis requires further clarification. Therefore, this study aims to evaluate the prognostic significance of major pathological response (MPR) in ESCC patients receiving nICT.

This is a retrospective multi-center study enrolling 306 ESCC patients undergoing nICT. The primary endpoints were recurrence-free survival (RFS) and recurrence patterns. Propensity score matching (PSM) was applied to address heterogeneity between groups. Kaplan-Meier curves and Cox regression analysis were utilized to analyze survival difference.

144 achieved a MPR, while 68 achieved a pathological complete response (pCR). Cox regression analysis identified MPR as an independent prognostic factor [HR = 0.48, 95%CI= (0.28 - 0.82), P = 0.007]. Survival analysis demonstrated that MPR patients experienced significantly improved RFS compared to non-MPR patients, before (P<0.001) and after PSM (P = 0.016). Importantly, the RFS of MPR patients was comparable to that of pCR patients (P = 0.319 in the unmatched cohort; P = 0.456 in the matched cohort). Furthermore, adjuvant therapy did not provide additional recurrence-free benefits for MPR patients. Compared to pCR patients, MPR patients exhibited a similar recurrence rate, with similar recurrence sites.

MPR represents a significant prognostic indicator in ESCC patients undergoing nICT, demonstrating prognostic outcomes comparable to those of pCR. These findings indicated that MPR could function as a surrogate endpoint for pCR, potentially influencing treatment strategies by refining follow-up protocol and the implementation of adjuvant therapy.