2213 - Optimizing Postoperative Adjuvant Strategies in Esophageal Squamous Cell Carcinoma Following Neoadjuvant Immunochemotherapy: A Multicenter Real-World Study
Presenter(s)
W. Shen, and X. Zhang; The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
Purpose/Objective(s): With the widespread adoption of neoadjuvant immunochemotherapy (nICT) for locally advanced resectable esophageal squamous cell carcinoma (ESCC), identifying optimal postoperative adjuvant strategies has emerged as a critical clinical challenge. This study aimed to evaluate the survival impact of different adjuvant treatment modalities and to characterize patient subgroups most likely to derive benefit.
Materials/Methods: In this multicenter retrospective real-world study, 612 ESCC patients from six Chinese medical centers who underwent R0 resection following nICT were categorized into three groups based on postoperative management: Clinical Observation (CO, n=336), Adjuvant Chemotherapy (POCT, n=81), and Adjuvant Chemotherapy plus Immunotherapy (POICT, n=195). Endpoints included overall survival (OS), disease-free survival (DFS), and recurrence patterns. Multivariate Cox regression and propensity score matching (PSM) were used to adjust for confounders. Subgroup analyses were performed based on pathological complete response (pCR) status and postoperative pathological stage (ypStage).
Results: Multivariate analysis revealed that both POCT and POICT significantly reduced the risk of death (HR=0.48, P=0.004; HR=0.49, P<0.001) and disease progression (HR=0.55, P=0.006; HR=0.66, P=0.006) compared to CO. Subgroup analyses demonstrated that among non-pathological complete response (non-pCR) patients, both POCT and POICT improved OS and DFS (P<0.05), with no significant difference between the two regimens. In pCR patients, only POICT conferred an OS benefit (P=0.014). Patients with postoperative pathological stage III showed improved OS (?²=7.601, P=0.022) and DFS (?²=9.579, P=0.008) with adjuvant therapy. After propensity score matching (PSM), 3-year OS (74.7% vs 79.8%) and DFS (63.1% vs 67.2%) were comparable between POCT and POICT (P>0.05). Adjuvant therapy was an independent prognostic factor for OS in patients with advanced yT, yN, and ypTNM stages, and for DFS in yN2 disease. Failure pattern analysis indicated no significant difference in locoregional recurrence or distant metastasis between POCT and POICT.
Conclusion: Postoperative adjuvant therapy provides survival benefits for ESCC patients after nICT, particularly for non-pCR patients and those with advanced pathological stages. However, the addition of immunotherapy to chemotherapy did not further enhance survival outcomes, underscoring the importance of pathology-directed adjuvant strategies.