ArticleFrontiers in immunology2026
Prediction of clinically significant complication following neoadjuvant chemoimmunotherapy in resectable esophageal cancer: a dynamic systemic inflammatory biomarker-based model.
Article in Frontiers in immunology, 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
Introduction: Neoadjuvant chemoimmunotherapy (NICT) shows promise in locally advanced esophageal squamous cell carcinoma (LA-ESCC), yet may induce complex inflammatory-immune changes that complicate postoperative risk stratification. Current static inflammatory indices lack generalizability across populations and timing. Methods: This single-center retrospective cohort study analyzed 273 patients. Patients were stratified by Clavien-Dindo grade into a non-significant complication (NSC) group (CD < II) and a clinically significant complication (CSC) group (CD ≥ II). Dynamic (Δ) inflammatory indices were constructed from pre- and post-NICT hematologic markers. Optimal cutoffs were determined via ROC analysis and the Youden index, after which each Δ indicator was transformed into a dichotomous variable. Significant predictors from univariable logistic regression were incorporated into the multivariable logistic regression, which integrated ΔNPR-SII2 with clinical factors to build a final predictive model. Results: Of the cohort, 212 and 61 patients were classified into the NSC and CSC groups, respectively. Multivariate logistic regression identified age ≥ 70 years (odds ratio [OR] = 2.37, 95% CI: 1.01-5.55), low body mass index (< 18.5; OR = 2.20, 95% CI: 1.08-4.50), an elevated ECOG score (≥ 2; OR = 3.98, 95% CI: 1.13-14.05), and ΔNPR-SII2 (OR = 8.34, 95% CI: 3.92-17.74) as independent predictors of major complications. The model demonstrated good discriminatory power, with an area under the curve (AUC) of 0.784 (95% CI: 0.724-0.844) and a bootstrap-validated C-index of 0.772. Calibration performance was satisfactory (Brier score = 0.138). Discussion: We developed and internally validated a dynamic inflammatory biomarker-based model for preoperative prediction of major complications post-NICT. The ΔNPR-SII2 index captures treatment-induced immune-inflammatory dysregulation and provides a clinically translatable tool for risk-adapted perioperative management.
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