ArticleThe oncologist2026
Lymphovascular and perineural invasion guides adjuvant therapy after neoadjuvant chemoimmunotherapy in esophageal squamous cell carcinoma.
Article in The oncologist, 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
backgroundLymphovascular (LVI) and perineural invasion (PNI) are adverse pathological features in esophageal squamous cell carcinoma (ESCC). We evaluated the prognostic significance of combined LVI/PNI (LNI) after neoadjuvant chemoimmunotherapy (nCIT) and the potential benefit of adjuvant therapy.
methodsWe retrospectively analyzed 473 ESCC patients undergoing nCIT followed by curative resection. LNI status was assessed in resected specimens. Survival outcomes were compared between LNI-positive and -negative patients using propensity score matching and multivariable Cox models. External validation was performed using an independent patient-level dataset.
resultsLNI was present in 21% of patients. LNI-positive patients had worse 3-year overall survival (OS) (49.8% vs 76.4%) and disease-free survival (DFS) (41.7% vs 69.3%), which remained significant after matching. LNI independently predicted inferior OS (hazard ratio [HR] 1.52, P = .022) and DFS (HR 1.40, P = .045). Recurrence occurred more frequently in LNI-positive patients (39.4% vs 19.8%, P < .001), predominantly locoregional. Among LNI-positive patients, adjuvant therapy improved 3-year OS (56.8% vs 32.4%) and DFS (49.7% vs 20.7%; adjusted HR 0.43, P = .002). External validation confirmed these findings, with independent prognostic impact of LNI and benefit from adjuvant therapy.
conclusionsLNI after nCIT is an independent adverse prognostic factor in ESCC. Patients with these high-risk pathological features have markedly worse outcomes but appear to derive significant benefit from adjuvant therapy, supporting its incorporation into postoperative management.
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