Glasgow prognostic score as a predictor of adjuvant nivolumab efficacy in esophageal squamous cell carcinoma

Adjuvant nivolumab is standard for locally advanced esophageal cancer patients without pathological complete response after neoadjuvant chemoradiotherapy, and this study evaluated its efficacy and the predictive value of the Glasgow Prognostic Score on survival. We retrospectively analyzed 33 patients diagnosed with stage II-III esophageal squamous cell carcinoma (ESCC) who were followed at our center between January 2020 and January 2025. These patients had undergone neoadjuvant chemoradiotherapy followed by R0 resection yet exhibited residual disease (ypT1-4 or ypN+). The relationship between disease-free survival (DFS) and overall survival (OS) and GPS (0,1,2) was analyzed. Our study shows that adjuvant nivolumab is effective in ESCC, with superior responses in patients with low Glasgow Prognostic Score and markedly reduced benefit in those with high GPS. Mean DFS was 43.2 months in GPS 0 patients (median not reached), compared with median DFS of 12 and 5 months in the GPS 1 and GPS 2 groups, respectively. Mean OS in the GPS 0 group was 49.5 months (median not reached), while median OS decreased to 27 months in GPS 1 and 10 months in GPS 2 patients. Adjuvant nivolumab improves survival in locally advanced ESCC with residual disease. Lower Glasgow Prognostic Score is associated with improved DFS and OS, underscoring the role of systemic inflammation in immunotherapy response. GPS may be a simple and cost-effective predictive biomarker for adjuvant immunotherapy.