Impact of clinical decisions on patient outcomes after neoadjuvant therapy in locally advanced resectable esophageal squamous cell carcinoma.

Background: Neoadjuvant therapy (NAT) is the standard treatment for locally advanced esophageal cancer. Nevertheless, the response to NAT varies significantly among patients. This study is aimed at comparing the influence of different clinical decisions on disease-free survival (DFS) and overall survival (OS) in patients evaluated as stable disease (SD) or clinical response (CR/PR) after NAT.

Methods: This retrospective, multicenter cohort study included patients with locally advanced and resectable ESCC who underwent NAT from January 2016 to January 2022. After NAT, patients were classified into CR/PR and SD groups. Each group was further divided into surgical and non-surgical subgroups. Kaplan-Meier survival analysis was used to compare OS and DFS between groups, and Cox regression was used to identify independent prognostic factors.

Results: A total of 518 patients were included, with 286 classified as CR/PR and 232 as SD. In the SD group, 170 patients (73.3%) underwent surgery, while 62 (26.7%) refused. In the CR/PR group, 246 patients (86.0%) underwent surgery, and 40 (14.0%) refused. Survival analysis revealed that surgery significantly improved OS and DFS in the SD group, and multivariate analysis identified surgery as an independent prognostic factor for both OS and DFS. In the CR/PR group, surgery significantly improved DFS and was an independent factor for DFS, but it did not significantly impact long-term OS.

Conclusions: In patients with clinically stable disease, surgery significantly improves both DFS and OS. In patients with clinical response, surgery improves DFS but has no significant impact on long-term OS.