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Background <p>Neoadjuvant chemoradiotherapy (NCRT) followed by surgery is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). Pathological complete response (pCR) is a key prognostic indicator, yet clinical outcomes and recurrence patterns in ESCC patients achieving pCR warrant further investigation.</p> Methods <p>We retrospectively analyzed patients with cT2-4aN0-3 ESCC who underwent NCRT followed by esophagectomy between 2014 and 2022. Patients were stratified into pCR (ypT0N0) and non-pCR groups. Survival and recurrence outcomes were assessed using Kaplan–Meier and Cox regression analyses.</p> Results <p>Among 136 patients (mean age 59.1 ± 7.2&#xa0;years, 90.4% male), 39 (28.7%) achieved pCR. With a median follow-up of 30&#xa0;months, the 5-year overall survival (OS) rate was 81.6% in the pCR group versus 39.2% in the non-pCR group (<i>p</i> &lt; 0.001), and the 5-year disease-free survival (DFS) rate was 70.1 vs. 31.0%, respectively (<i>p</i> &lt; 0.001). Recurrence occurred in 26.3% of pCR patients, significantly lower than the 65.9% in non-pCR patients (<i>p</i> &lt; 0.001). Multivariate analysis identified pCR as an independent favorable prognostic factor for OS (HR 0.351, 95% CI 0.121–0.980, <i>p</i> = 0.040) and ypTNM stage for both OS (HR 1.516, 95% CI 1.114–2.063, <i>p</i> = 0.006) and DFS (HR 1.733, 95% CI 1.381–2.174, <i>p</i> = 0.001).</p> Conclusion <p>Achieving pCR after NCRT is associated with significantly improved survival in ESCC patients. However, recurrence still occurs in a notable proportion of pCR patients, underscoring the need for further risk stratification and exploration of adjuvant strategies even in this favorable response group.</p>

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Clinical outcomes of esophageal squamous cell carcinoma with pathological complete response after neoadjuvant chemoradiotherapy and surgery

  • 期刊论文

  • 发表日期：

    2026年3月3日

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  • Xiaofeng Duan,
  • Zhengjun Li,
  • Ruizhen Wang,
  • Hongjing Jiang

摘要

Background

Neoadjuvant chemoradiotherapy (NCRT) followed by surgery is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). Pathological complete response (pCR) is a key prognostic indicator, yet clinical outcomes and recurrence patterns in ESCC patients achieving pCR warrant further investigation.

Methods

We retrospectively analyzed patients with cT2-4aN0-3 ESCC who underwent NCRT followed by esophagectomy between 2014 and 2022. Patients were stratified into pCR (ypT0N0) and non-pCR groups. Survival and recurrence outcomes were assessed using Kaplan–Meier and Cox regression analyses.

Results

Among 136 patients (mean age 59.1 ± 7.2 years, 90.4% male), 39 (28.7%) achieved pCR. With a median follow-up of 30 months, the 5-year overall survival (OS) rate was 81.6% in the pCR group versus 39.2% in the non-pCR group (p < 0.001), and the 5-year disease-free survival (DFS) rate was 70.1 vs. 31.0%, respectively (p < 0.001). Recurrence occurred in 26.3% of pCR patients, significantly lower than the 65.9% in non-pCR patients (p < 0.001). Multivariate analysis identified pCR as an independent favorable prognostic factor for OS (HR 0.351, 95% CI 0.121–0.980, p = 0.040) and ypTNM stage for both OS (HR 1.516, 95% CI 1.114–2.063, p = 0.006) and DFS (HR 1.733, 95% CI 1.381–2.174, p = 0.001).

Conclusion

Achieving pCR after NCRT is associated with significantly improved survival in ESCC patients. However, recurrence still occurs in a notable proportion of pCR patients, underscoring the need for further risk stratification and exploration of adjuvant strategies even in this favorable response group.