Prognostic factors and the Impact of Adjuvant Therapy on Survival Outcomes in ypT0-2N0M0 Oesophageal Squamous Cell Carcinoma

Abstract OBJECTIVES The role of adjuvant therapy in ypT0–2N0M0 oesophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to assess the impact of adjuvant therapy on overall survival (OS) and disease-free survival (DFS) and to develop prognostic nomogram models. METHODS Patients with ypT0-2N0M0 followed by radical oesophagectomy between 2011 and 2024 were reviewed. Propensity score matching (PSM) was applied to adjust for baseline imbalances between treatment groups. OS and DFS were estimated using the Kaplan–Meier method. Prognostic factors were evaluated by Cox proportional hazards model, and nomogram models were developed. RESULTS A total of 363 patients were enrolled in the study, of whom 67 received adjuvant therapy. Patients who received adjuvant therapy had significantly poorer OS and DFS compared with those who did not, both before and after PSM (P < 0.05). Multivariate analyses identified adjuvant therapy as an independent adverse prognostic factor for OS and DFS (P < 0.05). The nomogram demonstrated good discrimination for OS, with time-dependent areas under the receiver operating characteristic curve (AUCs) of 0.729 (95% CI: 0.623–0.835) and 0.716 (95% CI: 0.642–0.790) at 1 and 3 years, respectively, and acceptable discrimination for DFS, with corresponding AUCs of 0.673 (95% CI: 0.596–0.751) and 0.659 (95% CI: 0.589–0.728). CONCLUSIONS In patients with ypT0–2N0M0 ESCC, adjuvant therapy may not be associated with improved OS or DFS. The developed nomogram models demonstrated good performance in predicting individualized OS and DFS.