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Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study

  • Authors:
    • Feng Wang
    • Xiangyang Yu
    • Dongjie Yan
    • Lei Yang
    • Jianfei Zhu
    • Ran Yang
    • Yi Han
  • View Affiliations / Copyright

    Affiliations: Department of Minimally Invasive Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 100149, P.R. China, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518116, P.R. China, Department of Thoracic Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710068, P.R. China, Department of Thoracic Surgery, Anyang Tumor Hospital, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Anyang, Henan 455000, P.R. China
    Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 582
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    Published online on: October 10, 2025
       https://doi.org/10.3892/ol.2025.15328
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Abstract

The relationship between pathological complete response (pCR) and survival as well as recurrence characteristics in patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant immunochemotherapy has not been frequently investigated. The present study primarily examined the survival and recurrence patterns of pCR in these patients. Data were collected from 300 individuals diagnosed with stage II‑III ESCC who underwent neoadjuvant immunochemotherapy followed by surgery across four medical centers between 2019 and 2024. The Cox proportional hazards model and the Kaplan‑Meier method with propensity score matching (PSM) were utilized for survival analysis to examine the relationship between pCR and overall survival (OS) and recurrence‑free survival (RFS). The recurrence patterns among patients were evaluated. Of the 300 patients included in the present study, 80 achieved a pCR. Univariate and multivariate analyses utilizing the Cox proportional hazards model demonstrated that pCR was a statistically significant prognostic factor for OS and RFS (P<0.05). Utilizing PSM based on the achievement of pCR, survival analysis conducted using the Kaplan‑Meier method and log‑rank test demonstrated that patients in the pCR group exhibited significantly improved RFS (P<0.05). However, no statistically significant difference was observed in OS (P>0.05). The recurrence rate in the pCR group was 11.2%, with a local recurrence rate of 7.5% and a distant recurrence rate of 3.7%. Both rates were significantly decreased compared with those in the non‑pCR group (P<0.05). The mediastinal lymph node represented the most common site of recurrence in both groups. In patients with ESCC undergoing neoadjuvant immunochemotherapy, pCR indicated improved OS and RFS; however, the association between pCR and OS was not statistically significant. Concurrently, pCR was associated with reduced local and distant recurrence rates, and the recurrence pattern of patients in the pCR group differed from that of patients in the non‑pCR group. Future research should involve larger sample sizes to elucidate the relationship between pCR and survival, as well as its influence on recurrence patterns.
View Figures

Figure 1

Flow diagram of case selection.

Figure 2

Forest plot of multivariate analysis
of OS by Cox proportional hazards model. OS, overall survival; CI,
confidence interval; pCR, pathological complete response.

Figure 3

Forest plot of multivariate analysis
of RFS by Cox proportional hazards model. RFS, recurrence free
survival; CI, confidence interval; pCR, pathological complete
response.

Figure 4

Chart of propensity scores
distribution. Each unit represents a case; control units represent
cases in the non-pCR group and treated units represent cases in the
pCR group. pCR, pathological complete response.

Figure 5

Kaplan-Meier curves of survival
analysis. (A) OS before PSM; (B) RFS before PSM; (C) OS after PSM;
(D) RFS after RFS. OS, overall survival; RFS, recurrence-free
survival; PSM, propensity score matching; pCR, pathological
complete response.

Figure 6

Pie charts of recurrence sites.
Recurrence sites in (A) pCR group and (B) non-pCR group. pCR,
pathological complete response; LN, lymph node.
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Copy and paste a formatted citation
Spandidos Publications style
Wang F, Yu X, Yan D, Yang L, Zhu J, Yang R and Han Y: Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study. Oncol Lett 30: 582, 2025.
APA
Wang, F., Yu, X., Yan, D., Yang, L., Zhu, J., Yang, R., & Han, Y. (2025). Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study. Oncology Letters, 30, 582. https://doi.org/10.3892/ol.2025.15328
MLA
Wang, F., Yu, X., Yan, D., Yang, L., Zhu, J., Yang, R., Han, Y."Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study". Oncology Letters 30.6 (2025): 582.
Chicago
Wang, F., Yu, X., Yan, D., Yang, L., Zhu, J., Yang, R., Han, Y."Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study". Oncology Letters 30, no. 6 (2025): 582. https://doi.org/10.3892/ol.2025.15328
Copy and paste a formatted citation
x
Spandidos Publications style
Wang F, Yu X, Yan D, Yang L, Zhu J, Yang R and Han Y: Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study. Oncol Lett 30: 582, 2025.
APA
Wang, F., Yu, X., Yan, D., Yang, L., Zhu, J., Yang, R., & Han, Y. (2025). Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study. Oncology Letters, 30, 582. https://doi.org/10.3892/ol.2025.15328
MLA
Wang, F., Yu, X., Yan, D., Yang, L., Zhu, J., Yang, R., Han, Y."Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study". Oncology Letters 30.6 (2025): 582.
Chicago
Wang, F., Yu, X., Yan, D., Yang, L., Zhu, J., Yang, R., Han, Y."Survival and recurrence characteristics of patients with esophageal cancer with a pathological complete response after neoadjuvant immunochemotherapy followed by surgery: A multicenter propensity score matching study". Oncology Letters 30, no. 6 (2025): 582. https://doi.org/10.3892/ol.2025.15328
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