Prognostic Value of the PILE Score in Esophageal Squamous Cell Carcinoma Treated with Neoadjuvant Chemoradiotherapy

Background: This retrospective cohort study evaluated the role of the PILE score as a prognostic biomarker for overall survival (OS) and progression-free survival (PFS) in patients with locally advanced esophageal squamous cell carcinoma (ESCC) who were treated with neoadjuvant chemoradiotherapy (nCRT). Methods: This study included 108 patients with ESCC treated with weekly paclitaxel-carboplatin and concurrent radiotherapy at Erzurum Atatürk University Faculty of Medicine Hospital between January 2018 and April 2024. Patients were categorized into low- (PILE score 0-1) and high-risk (PILE score 2-3) groups. Kaplan-Meier analysis and Cox regression models were used to evaluate the association between the PILE score and survival outcomes. Results: The results showed that the high-risk PILE group had significantly shorter median OS (18.6 months vs. not reached; p < 0.001) and PFS (12.4 months vs. not reached; p < 0.001) than the low-risk group. Multivariate analysis showed that the PILE risk classification [hazard ratio (HR) = 2.527; 95% confidence interval (CI): 1.380-4.629; p = 0.003] and surgical resection (HR = 0.249; 95% CI: 0.090-0.683; p = 0.007) were independent prognostic factors for OS, whereas the PILE risk classification (HR = 2.932; 95% CI: 1.525-5.639; p = 0.001) and surgical resection (HR = 0.131; 95% CI: 0.044-0.394; p < 0.001) were independent prognostic factors for PFS. Conclusions: The study concludes that the PILE score is a robust prognostic tool for OS and PFS in patients with ESCC undergoing nCRT, highlighting its potential for risk stratification and personalized treatment planning.