Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study

The relationship between pathological complete response (pCR) and survival as well as recurrence characteristics in patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant immunochemotherapy has not been frequently investigated. The present study primarily examined the survival and recurrence patterns of pCR in these patients. Data were collected from 300 individuals diagnosed with stage II-III ESCC who underwent neoadjuvant immunochemotherapy followed by surgery across four medical centers between 2019 and 2024. The Cox proportional hazards model and the Kaplan-Meier method with propensity score matching (PSM) were utilized for survival analysis to examine the relationship between pCR and overall survival (OS) and recurrence-free survival (RFS). The recurrence patterns among patients were evaluated. Of the 300 patients included in the present study, 80 achieved a pCR. Univariate and multivariate analyses utilizing the Cox proportional hazards model demonstrated that pCR was a statistically significant prognostic factor for OS and RFS (P<0.05). Utilizing PSM based on the achievement of pCR, survival analysis conducted using the Kaplan-Meier method and log-rank test demonstrated that patients in the pCR group exhibited significantly improved RFS (P<0.05). However, no statistically significant difference was observed in OS (P>0.05). The recurrence rate in the pCR group was 11.2%, with a local recurrence rate of 7.5% and a distant recurrence rate of 3.7%. Both rates were significantly decreased compared with those in the non-pCR group (P<0.05). The mediastinal lymph node represented the most common site of recurrence in both groups. In patients with ESCC undergoing neoadjuvant immunochemotherapy, pCR indicated improved OS and RFS; however, the association between pCR and OS was not statistically significant. Concurrently, pCR was associated with reduced local and distant recurrence rates, and the recurrence pattern of patients in the pCR group differed from that of patients in the non-pCR group. Future research should involve larger sample sizes to elucidate the relationship between pCR and survival, as well as its influence on recurrence patterns.