ArticleAnnals of surgical oncology2026
Long-term Oncologic Outcomes Following Pathologic Complete Response for Esophageal Cancer.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile multimodality therapy for locally advanced esophageal cancer evolves, neoadjuvant chemoradiation has been a longstanding treatment paradigm. Pathologic complete response (pCR) rates vary by histology: 25% for adenocarcinoma (AC) and up to 50% for squamous cell carcinoma (SCC). Long-term outcomes after pCR remain poorly understood but important to define as multiple treatment options emerge. PATIENTS AND
methodsWe analyzed patients with cT2+/N+M0 esophageal AC or SCC treated with neoadjuvant chemoradiation and resection from an institutional database. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier and multivariable Cox models. A risk score for recurrence was developed and validated using National Cancer Data Base data.
resultsOf 830 patients, 37.1% achieved pCR (n = 250/720, 34.2% for AC and n = 58/100, 58.0% for SCC). pCR was associated with prolonged OS (5-year OS: 56.2% versus 35.0% for residual disease, p < 0.001). pCR remained an independent predictor of OS after adjustment for known predictors of OS (HR 0.58, p < 0.001). Recurrence typically occurred within 2 years then plateaued, with 5-year RFS of 72.6% for AC and 83.0% for SCC. Clinical T3/T4, cN+, fewer lymph nodes examined, and AC histology were independently associated with worse RFS. A weighted risk score for recurrence was developed, which externally predicted OS after pCR in the NCDB (HR 1.12 per point, p < 0.001). Median OS was 7.8 years for cases with score 0-3 versus 5.7 years for cases with score 4-5.
conclusionspCR after neoadjuvant chemoradiotherapy is a strong predictor of survival, but recurrence remains common. Further investigation into adjuvant therapies for high-risk pCR patients is needed.
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