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Purpose <p>Esophageal stricture is a common and debilitating late-onset complication after definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC). Several risk factors have been identified; however, evidence remains limited in advanced (T2–T4) disease, particularly regarding quantitative endoscopic parameters and nutritional status.</p> Methods <p>We retrospectively analyzed 93 patients with T2–T4 ESCC who achieved complete response after dCRT between 2008 and 2025. Tumor characteristics, nutritional indices, and treatment parameters were evaluated. Independent predictors of post-dCRT stricture were assessed using multivariate logistic regression. Receiver operating characteristic analyses were performed. Survival outcomes were analyzed using time-dependent Cox proportional hazards models.</p> Results <p>Clinically significant strictures developed in 44.1% of patients. Multivariate analysis identified three independent predictors: pre-treatment endoscopic non-passability (OR = 18.3, <i>p</i> &lt; 0.001), greater tumor length (OR = 1.61, <i>p</i> = 0.008), and higher luminal obstruction ratio (OR = 1.07, <i>p</i> = 0.007). Lower baseline serum albumin showed a trend toward an inverse association with stricture development. No association was observed between stricture risk and chemotherapy regimen or radiation dose. Patients who developed strictures had worse overall survival (HR = 2.17, <i>p</i> = 0.009) and disease-specific survival (HR = 2.40, <i>p</i> = 0.025).</p> Conclusion <p>In T2–T4 ESCC treated with dCRT, stricture formation was strongly associated with impaired endoscopic patency and larger tumor burden. Poorer baseline nutritional status may also increase risk. Pre-treatment endoscopic and nutritional assessments may help identify high-risk patients and guide early supportive interventions.</p>

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Predictors of Post-Definitive Chemoradiotherapy Esophageal Stricture in T2–T4 Esophageal Squamous Cell Carcinoma:

  • 期刊论文

  • 发表日期：

    2026年3月11日

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  • Ryosuke Ishida,
  • Kenji Nagata,
  • Susumu Horitani,
  • Ryoko Futai,
  • Nagahiro Tokuyama,
  • Kazutoshi Tobimatsu,
  • Yuzo Kodama

摘要

Purpose

Esophageal stricture is a common and debilitating late-onset complication after definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC). Several risk factors have been identified; however, evidence remains limited in advanced (T2–T4) disease, particularly regarding quantitative endoscopic parameters and nutritional status.

Methods

We retrospectively analyzed 93 patients with T2–T4 ESCC who achieved complete response after dCRT between 2008 and 2025. Tumor characteristics, nutritional indices, and treatment parameters were evaluated. Independent predictors of post-dCRT stricture were assessed using multivariate logistic regression. Receiver operating characteristic analyses were performed. Survival outcomes were analyzed using time-dependent Cox proportional hazards models.

Results

Clinically significant strictures developed in 44.1% of patients. Multivariate analysis identified three independent predictors: pre-treatment endoscopic non-passability (OR = 18.3, p < 0.001), greater tumor length (OR = 1.61, p = 0.008), and higher luminal obstruction ratio (OR = 1.07, p = 0.007). Lower baseline serum albumin showed a trend toward an inverse association with stricture development. No association was observed between stricture risk and chemotherapy regimen or radiation dose. Patients who developed strictures had worse overall survival (HR = 2.17, p = 0.009) and disease-specific survival (HR = 2.40, p = 0.025).

Conclusion

In T2–T4 ESCC treated with dCRT, stricture formation was strongly associated with impaired endoscopic patency and larger tumor burden. Poorer baseline nutritional status may also increase risk. Pre-treatment endoscopic and nutritional assessments may help identify high-risk patients and guide early supportive interventions.