Risk factors and prognosis of postoperative early relapse after neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma: a retrospective study.

Abstract

Background: This study aimed to identify risk factors associated with early postoperative relapse and evaluate their impact on survival outcomes after neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (LA-ESCC), thereby informing strategies to optimize postoperative clinical management.

Methods: Patients with LA-ESCC who underwent neoadjuvant therapy followed by surgical resection at West China Hospital between January 2018 and December 2023 were screened and enrolled. Patients were categorized into early relapse (≤ 6 months) and late relapse (> 6 months) groups based on the interval from surgery to relapse.

Results: A total of 183 LA-ESCC patients who received neoadjuvant therapy followed by surgical resection were included, with 79 experiencing early relapse and 104 experiencing late relapse. Logistic regression analysis showed that postoperative TNM stage III-IV, ypN + stage, R1 resection, lymphovascular invasion (LVI), perineural invasion (PI), and absence of postoperative adjuvant therapy were risk factors for early relapse (p < 0.05). Multivariate regression further identified R1 resection as an independent predictor (p < 0.05). Cox regression analysis demonstrated that LI was a prognostic factor for overall survival (OS) in patients with early relapse (p = 0.045). Kaplan-Meier analysis revealed significantly reduced OS (12.5 months vs. 26.9 months, HR = 2.96, p < 0.001) and survival after relapse (SAR) (5.9 months vs. 11.0 months, HR = 1.81, p < 0.001) in the early relapse group compared to the late relapse group. However, relapse patterns did not differ significantly between groups (p > 0.05).

Conclusion: R1 resection is an independent risk factor for rapid postoperative relapse in LA-ESCC patients following neoadjuvant therapy. Furthermore, LVI significantly affects patients survival outcomes, and early relapse was strongly associated with reduced overall survival (OS).