Long-term clinical outcome of esophageal squamous cell carcinoma with residual disease after neoadjuvant chemoradiotherapy and surgery

This study aimed to investigate the long-term clinical outcomes of patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy with residual disease and to identify relevant clinicopathological prognostic factors. A total of 106 patients who underwent nCRT and surgery were identified. The chemotherapy regimen consisted of cisplatin plus 5-fluorouracil every 4 weeks, along with weekly carboplatin combined with paclitaxel, and the prescribed radiotherapy dose was either 41.4 Gy or 50.4 Gy. Most patients experienced tumor stage migration following nCRT and esophagectomy, such as upstaging or downstaging. Patients with ESCC undergoing trimodality therapy were categorized into three groups based on residual tumor status: ypT+N+, ypT+N0, and ypT0N+. In our cohort, the median disease-free survival (DFS) and overall survival (OS) were 8.2 months and 14.0 months, respectively. Pathological T status emerged as an independent prognostic factor associated with DFS and OS in both univariate and multivariate analyses. Patients with upstaging demonstrated inferior DFS and OS compared to those without upstaging, while patients experiencing downstaging showed superior DFS and OS compared to those without downstaging. Furthermore, DFS and OS appeared relatively worse in patients with ypT+N+ compared to those with ypT+N0 and ypT0N+. In conclusion, pathological T status serves as an independent prognostic factor for DFS and OS in ESCC patients with residual disease following nCRT and surgery, and prognosis is significantly correlated with upstaging or downstaging after nCRT. Identifying patients with the poorest prognosis is important, as additional adjuvant treatment may be necessary.