Pathologic complete response after neoadjuvant immunochemotherapy: Persistent recurrence risk highlights the need for...

Area of Science:

• Oncology
• Gastrointestinal Oncology
• Neoadjuvant Therapy

Background:

• Pathologic complete response (pCR) after neoadjuvant therapy is a favorable prognostic indicator in esophageal squamous cell carcinoma (ESCC).
• The long-term outcomes and recurrence patterns for ESCC patients achieving pCR following neoadjuvant immunochemotherapy (nICT) are not well-defined.

Purpose of the Study:

• To characterize recurrence patterns in ESCC patients who achieved pCR after nICT.
• To identify prognostic factors influencing recurrence-free survival (RFS) and overall survival (OS) in this specific patient cohort.

Main Methods:

• A multicenter retrospective cohort study involving 2,135 ESCC patients treated with nICT and surgery across 26 Chinese centers (2019-2023).
• Analysis of recurrence patterns, RFS, and OS in 474 patients who achieved pCR.
• Cox regression analysis was employed to identify independent prognostic factors for RFS and OS.

Main Results:

• 22.2% of patients achieved pCR after nICT. Within a median follow-up of 32.8 months, 12.7% experienced recurrence, primarily distant metastases (63.3%) within 2 years.
• The 2-year RFS and OS rates were 89.6% and 92.1%, respectively.
• Advanced clinical nodal stage (cN2-3) was an independent predictor of inferior RFS (aHR=1.83), but adjuvant treatment did not significantly impact survival.

Conclusions:

• ESCC patients achieving pCR post-nICT demonstrate excellent short-term outcomes but maintain a risk of distant recurrence.
• Advanced clinical nodal stage is a significant risk factor for recurrence, necessitating further investigation.
• Risk-adapted postoperative management strategies may be more beneficial than routine adjuvant therapy for these patients.