Abstract 188P
Background
This study explores the prognostic significance of pathological response in primary tumors(PTs) and lymph nodes (LNs) among locally advanced esophageal squamous cell carcinoma (LA-ESCC) patients received neoadjuvant chemo-immunotherapy (nICT).
Methods
Two senior pathologists retrospectively examined pathological regression of PTs and LNs from patients received nICT followed by esophagectomy at our center. PTs were evaluated by Becker criteria, while LN regression (LNR) assessment was utilized Akaike Information Criterion and Harrell's C-index to gauge the predictive accuracy of various classifications for prognosis. Primary endpoint was to evaluate the prognostic implications of pathological regression in PTs and LNs to nICT. Secondary endpoint was the recurrence patterns.
Results
A total of 141 patients were screened, with 2,296 LNs examined. The pathological complete response (pCR) rate was 21.3%, and major pathological response (MPR) rate was 38.3%. As of March 2024, the median follow-up was 32 months (IQR, 19-38). Patients with pCR exhibited significantly better overall survival (OS) and progression-free survival (PFS) compared to those who did not (P<0.05). Multivariate analysisidentified the response of PTs as a crucial risk factor for recurrence (HR, 2.882; 95% CI, 1.381-6.013; P=0.005) and mortality (HR, 10.760; 95% CI, 2.445-47.349; P=0.002), whereas LNR had limit prognostic value. Areceiver operating characteristic (ROC) analysis revealedMPR to be a superior predictor of prognosis than pCR of the PTs (pCR-PTs) (P<0.05). Notably, MPR achievement was associated with superior OS (P<0.0001) and PFS (P=0.019). Furthermore, recurrence patterns showed more than half of the patients experienced progression within one year (n=44/66, 66.7%), predominantly locoregional recurrence (n=31/44, 88.6%). Conversely, distant metastatic tended to manifest after the first year(n=13/16, 81.2%).
Conclusions
After receiving nICT, the pathologicalregression of the PTs emerged as a better prognostic predictor than LNR. Moreover, MPR demonstrated superior predictive efficacy compared to pCR-PTs.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.