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Background <p>Despite standardized multimodal treatment, long-term outcomes in patients with locally advanced esophageal squamous cell carcinoma (ESCC) remain variable. We aimed to identify preoperative and pathological factors associated with survival following neoadjuvant therapy and esophagectomy.</p> Patients and Methods <p>A retrospective cohort of 1017 patients who received surgery following neoadjuvant treatment at West China Hospital, Sichuan University, between December 2008 and January 2022 was analyzed. Clinical, pathological, and laboratory data were collected. Overall survival (OS) and disease-free survival (DFS) were evaluated using Cox proportional hazards models. Restricted cubic spline (RCS) analyses were employed to examine nonlinear associations of continuous predictors.</p> Results <p>Independent predictors of worse OS included male sex (hazard ratio [HR] = 1.43, 95% confidence interval [CI]: 1.02–2.01; <i>P </i>&lt; 0.05) and nodal stage N1 (HR = 2.38), N2 (HR = 3.21), and N3 (HR = 5.32; all <i>P </i>&lt; 0.01). Pathological complete response (pCR) was protective (HR = 0.56, 95% CI: 0.41–0.76; <i>P</i> &lt; 0.01). Higher body mass index (BMI) was associated with improved OS (HR = 0.92, 95% CI: 0.89–0.96; <i>P</i> &lt; 0.01), while higher albumin–bilirubin (ALBI) score predicted worse survival (HR = 1.56, 95% CI: 1.20–2.02; <i>P</i> &lt; 0.01). Similar results were observed for DFS. RCS analysis revealed that body mass index (BMI) below 22&#xa0;kg/m<sup>2</sup> and ALBI score above −2.0 were associated with significantly worse outcomes.</p> Conclusions <p>Sex, nodal stage, pCR, BMI, and ALBI were independently associated with long-term survival after neoadjuvant therapy and surgery for ESCC. Integrating pathological and physiological factors may improve preoperative risk assessment and support individualized optimization strategies.</p>

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Preoperative Physiological Reserve and Pathological Response as Independent Predictors of Survival in Esophageal Squamous Cell Carcinoma after Neoadjuvant Therapy

  • 期刊论文

  • 发表日期：

    2025年12月6日

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  • Ruichen Cui,
  • Jiahan Cheng,
  • Xiaohu Hao,
  • Longqi Chen,
  • Yushang Yang

摘要

Background

Despite standardized multimodal treatment, long-term outcomes in patients with locally advanced esophageal squamous cell carcinoma (ESCC) remain variable. We aimed to identify preoperative and pathological factors associated with survival following neoadjuvant therapy and esophagectomy.

Patients and Methods

A retrospective cohort of 1017 patients who received surgery following neoadjuvant treatment at West China Hospital, Sichuan University, between December 2008 and January 2022 was analyzed. Clinical, pathological, and laboratory data were collected. Overall survival (OS) and disease-free survival (DFS) were evaluated using Cox proportional hazards models. Restricted cubic spline (RCS) analyses were employed to examine nonlinear associations of continuous predictors.

Results

Independent predictors of worse OS included male sex (hazard ratio [HR] = 1.43, 95% confidence interval [CI]: 1.02–2.01; P < 0.05) and nodal stage N1 (HR = 2.38), N2 (HR = 3.21), and N3 (HR = 5.32; all P < 0.01). Pathological complete response (pCR) was protective (HR = 0.56, 95% CI: 0.41–0.76; P < 0.01). Higher body mass index (BMI) was associated with improved OS (HR = 0.92, 95% CI: 0.89–0.96; P < 0.01), while higher albumin–bilirubin (ALBI) score predicted worse survival (HR = 1.56, 95% CI: 1.20–2.02; P < 0.01). Similar results were observed for DFS. RCS analysis revealed that body mass index (BMI) below 22 kg/m2 and ALBI score above −2.0 were associated with significantly worse outcomes.

Conclusions

Sex, nodal stage, pCR, BMI, and ALBI were independently associated with long-term survival after neoadjuvant therapy and surgery for ESCC. Integrating pathological and physiological factors may improve preoperative risk assessment and support individualized optimization strategies.