Abstract
ABSTRACT
Background
Non‐pathological complete response (non‐pCR) is common in esophageal squamous cell carcinoma (ESCC) patients after neoadjuvant therapy, yet evidence guiding long‐term outcomes and postoperative risk stratification in the immunotherapy era remains limited.
Methods
We retrospectively enrolled consecutive ESCC patients treated with neoadjuvant immunochemotherapy (nICT) or chemotherapy alone (nCT) followed by esophagectomy and restricted analyses to non‐pCR cases. Primary endpoints were five‐year overall survival (OS) and event‐free survival (EFS). A 1:1 optimal propensity score matching (PSM) procedure and administrative censoring at 60 months were applied. Survival outcomes were assessed using Kaplan–Meier and Cox proportional hazards analyses.
Results
Among 366 patients with non‐pCR disease, 164 matched pairs were generated. After matching, nICT demonstrated a higher major pathological response (MPR) rate (19.5% vs. 6.1%), a lower ypT4 proportion (3.7% vs. 22.0%), and fewer recurrence/metastasis rate (40.2% vs. 58.5%), all
p
p
= 0.005), whereas no independent association with OS was observed (HR 0.94, 95% CI 0.70–1.27;
p
= 0.707). Open esophagectomy (OE), ypN2‐3 disease, and perineural invasion (PNI) were associated with worse EFS, whereas lower Ki‐67 expression and postoperative adjuvant treatment were associated with better EFS. PNI was associated with worse OS, and postoperative adjuvant treatment was associated with better OS.
Conclusion
Among non‐pCR ESCC patients after neoadjuvant therapy and surgery, nICT was associated with lower recurrence risk and improved five‐year EFS compared with nCT, whereas a significant OS advantage was not observed. Pathological factors (PNI, high Ki‐67, and residual nodal burden) and postoperative treatment may help inform risk stratification, although the observational treatment associations should be interpreted cautiously.