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Pretreatment thymic computed tomography density predicts pathological response and survival after neoadjuvant
Zhenyuan Yang1, Yizhou Huang1, Hongmu Li1
1Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China; National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China; Clinical Research Center for Thoracic Tumors of Fujian Province, Fuzhou, China.
Introduction:
Current biomarkers for neoadjuvant immunochemotherapy (NICT) in locally advanced esophageal squamous cell carcinoma (ESCC) focus on tumor-intrinsic features, while host immune competence remains unexamined. The thymus, a central organ for T-cell maturation, undergoes progressive fatty involution captured non-invasively by computed tomography (CT) attenuation. We investigated whether pre-treatment thymic density on contrast-enhanced CT predicts pathological response and survival in ESCC patients undergoing NICT.
Materials And Methods:
This retrospective study included 336 patients with locally advanced ESCC who received NICT followed by esophagectomy. Thymic density was measured on pre-treatment contrast-enhanced CT. Using X-tile with overall survival (OS) as the endpoint, a cutoff of -65.10 Hounsfield units stratified patients into high (H-TRD, >-65.10 HU; n = 104) and low (L-TRD, ≤-65.10 HU; n = 232) thymic radiographic density groups.
Results:
The H-TRD group showed higher pathological complete response (pCR) (P = 0.009) and major pathological response (MPR) rates (P = 0.007), and longer OS (P = 0.001) and disease-free survival (DFS) (P = 0.003). On multivariable analysis, H-TRD independently predicted pCR (P = 0.006), MPR (P = 0.007), OS (P = 0.002), and DFS (P = 0.003). Thymic density outperformed thymic area, and its prognostic value remained robust across subgroups. Competing risk analysis confirmed lower cumulative recurrence in the H-TRD group (Gray's test, P = 0.034).
Conclusion:
Pre-treatment thymic density on contrast-enhanced CT independently predicts pathological response and survival in locally advanced ESCC treated with neoadjuvant immunochemotherapy, offering a host-informed approach to patient stratification. Prospective multicenter validation with correlative immune analyses is warranted.
