新辅助化免治疗（NICT）达到病理完全缓解（pCR）早期复发的高危因素

新辅助化免治疗（Neoadjuvant immunochemotherapy，NICT）达到病理完全缓解（pCR）早期复发的高危因素
食管鳞癌NICT达到病理完全缓解（pCR）早期复发的高危因素包括：NICT周期数，治疗-手术间期，低BMI。高T分期，高龄。术后辅助治疗未显示生存获益。

Beyond Pathological Complete Response: Identifying High-Risk Patients for Early Recurrence Despite Achieving pCR with Neoadjuvant Immunochemotherapy in Esophageal Squamous Cell Carcinoma
Objective: Neoadjuvant immunochemotherapy (NICT) has emerged as a promising approach for locally advanced esophageal squamous cell carcinoma (ESCC), achieving significant rates of pathological complete response (pCR). However, the prognosis and risk factors for recurrence in pCR patients remain underexplored. This study aimed to evaluate the prognosis and identify prognostic factors in ESCC patients who achieved pCR following NICT.
Methods: We conducted a retrospective analysis of 154 patients with ESCC who achieved pCR after NICT followed by esophagectomy at Fudan University Shanghai Cancer Center between January 2020 and June 2025. Patients received platinum-based chemotherapy combined with various immune checkpoint inhibitors. The primary endpoints were 3-year disease-free survival (DFS) and overall survival (OS). Survival analysis was performed using Kaplan-Meier curves and log-rank tests. Prognostic factors were assessed via Cox proportional hazards regression.
Results: After a median follow-up of 25 months (IQR, 22-28), the 3-year DFS and OS rates were 72% and 88%, respectively. Multivariate analysis identified that undergoing ≥3 cycles of NICT (HR=6.598, 95% CI 1.640-26.549, P=0.008), a treatment-to-surgery interval of <5 weeks (HR=4.374, 95% CI 1.070-17.869, P=0.040), and a BMI <23.9 kg/m² (HR=5.083, 95% CI 1.052-24.566, P=0.043) were independent risk factors for reduced DFS. Higher clinical T-stage (cT) was also associated with worse DFS (P=0.019). For OS, older age (HR=1.234 per year, 95% CI 1.074-1.417, P=0.003) and BMI <23.9 kg/m² (HR=62.560, 95% CI 2.892-1353.481, P=0.008) were independent risk factors, with higher cT-stage also showing a probable association (P=0.029). Notably, postoperative adjuvant therapy did not significantly improve either DFS or OS in this cohort.
Conclusion: Despite achieving pCR after NICT, a subset of ESCC patients remains at risk for recurrence and death. Key risk factors include more extensive NICT cycles, a shorter treatment-to-surgery interval, lower BMI, advanced clinical T-stage, and older age, whereas adjuvant therapy did not demonstrate a survival benefit. These factors may help stratify pCR patients for tailored postoperative surveillance strategies.

Zongpu Zhang (1), Bin Li (2), Haiquan Chen (1), (1) Fudan University Shanghai Cancer Center, Shanghai, Shanghai, (2) Fudan University Shanghai Cancer Center, shanghai, Shanghai