Recurrence Pattern and Prognostic Value of Major Pathological Response in Patients with Locally Advanced Oesophageal...

Background/Objectives: Major pathological response (MPR) has been suggested as a potential surrogate marker for assessing the efficacy of neoadjuvant therapy. However, its prognostic value and association with postoperative recurrence patterns remain unclear in patients with locally advanced oesophageal squamous cell carcinoma (ESCC) treated with neoadjuvant immunochemotherapy. This multicentre study aimed to investigate the relationship between MPR status, survival outcomes, and recurrence characteristics in this population. Methods: A total of 305 patients with locally advanced ESCC who received neoadjuvant immunochemotherapy followed by surgical resection at four medical centres in China between December 2019 and April 2024 were retrospectively enrolled in this study. Prognostic factors for overall survival (OS) and recurrence-free survival (RFS) were analyzed using Cox proportional hazards regression models. Propensity score matching (PSM) was performed to balance baseline characteristics between patients with and without MPR, and survival outcomes and postoperative recurrence patterns were subsequently compared. Results: Among the 305 patients, 115 (37.7%) achieved MPR. Multivariate analysis identified MPR and the number of neoadjuvant treatment cycles as independent prognostic factors for both OS and RFS (p < 0.05). After PSM, patients with MPR showed significantly improved OS and RFS compared with those without (p < 0.05). Postoperative recurrence occurred less frequently in the MPR group than in the non-MPR group (13.9% vs. 42.1%, respectively; p < 0.05), with reductions in both locoregional and distant recurrence. Conclusions: In patients with locally advanced ESCC receiving neoadjuvant immunochemotherapy and surgery, achieving MPR is associated with improved survival outcomes and a lower risk of postoperative recurrence. MPR may serve as a useful prognostic indicator for this population.