Tertiary Lymphoid Structures Predict Efficacy of Neoadjuvant Immunochemotherapy in Esophageal Squamous Cell Carcinoma

Neoadjuvant immunochemotherapy holds tremendous potential for patients with esophageal squamous cell carcinoma (ESCC); however, effective biomarkers for predicting its efficacy are lacking. This study explored the correlation between tertiary lymphoid structures (TLSs) with pathological response and disease-free survival (DFS) to predict the efficacy of neoadjuvant immunochemotherapy in ESCC.

We enrolled 104 patients with ESCC who underwent neoadjuvant immunochemotherapy and radical surgery. We retrospectively analyzed the general clinical data, pre-surgery blood routine results, and post-surgery pathological data of all participants. TLSs in ESCC tissue sections were determined using hematoxylin-eosin staining. Univariate chi-square and multivariate logistic analyses were used to determine the correlation of hematological parameters and TLSs with major pathological response (MPR). The Kaplan-Meier method, along with univariate and multivariate Cox regression analyses, were employed to evaluate the prognostic significance of the studied parameters on DFS.

TLSs were significantly associated with the efficacy of neoadjuvant immunochemotherapy in patients with resectable ESCC. Logistic analysis found that TLSs positivity (odds ratio OR=3.252, p=0.039) and platelet-to-lymphocyte ratio<173.155 (OR=0.393, p=0.025) were independent predictors of MPR. Cox regression analyses identified TLSs (HR=0.318, p=0.008) as an independent prognostic factor for patients with ESCC.

In patients with ESCC, TLSs are promising indicators for determining the efficacy of neoadjuvant immunochemotherapy.