Chemotherapy Response as a Predictor of Survival in Post-neoadjuvant Esophagectomy Specimens

Background Esophageal carcinoma is one of the most common cancers worldwide, which is conventionally treated with neoadjuvant chemoradiation and surgery. Presurgical treatment impacts outcomes by various factors. Objective This study aims to evaluate the prognostic significance of chemotherapy response in esophagectomy specimens and its association with survival outcomes in a post-neoadjuvant setting. Methods One hundred eighteen in-house post-neoadjuvant chemoradiation resection cases for esophageal carcinoma at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, with a follow-up period of at least six years were included in the study. Clinical T and N stage, current status and sites, and time of disease progression were retrieved from hospital archives. Pathological T and N stage and chemotherapy response scores (CRSs), along with various other factors, were assessed during the histopathological review. Overall survival (OS) and progression-free survival (PFS) were calculated and statistically analyzed by IBM SPSS Statistics for Windows, Version 29 (Released 2021; IBM Corp., Armonk, New York, United States). Results In a study of 118 patients, 68 (57.6%) died. The median OS was 65 months, and the five-year survival rate was 59.6%. Prognostic factors identified in the univariate analysis included age, clinical T stage, pathological T stage, pathological N stage, and CRS. ypT0 had a median survival of 72 months, significantly longer than ypT1 (65 months), ypT2 (36 months), and ypT3 (24 months). Similar trends were observed for improving CRSs. Disease progression occurred in 37 patients (31.35%), with a median PFS of 82.93 months. Multivariate analysis revealed that only CRS score 2 was statistically significant in predicting OS outcomes. Conclusion The study found a positive correlation between improved CRSs and OS/PFS, as well as between decreased pathological T stage and survival. It highlights the need for grading systems to include downstaged lymph nodes in therapy response assessments.