ORIGINAL RESEARCH article

Front. Immunol.

Sec. Cancer Immunity and Immunotherapy

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1599526

This article is part of the Research TopicCommunity Series in Novel Reliable Approaches for Prediction and Clinical Decision-making in Cancer: Volume IIView all 6 articles

The Prognostic Power of Major Pathological Response in Esophageal Squamous Cell Carcinoma Patients Undergoing Neoadjuvant Chemoimmunotherapy: a Multi-center Cohort Study

Provisionally accepted
Shuhan XieShuhan Xie1Shijie HuangShijie Huang2Zilu TangZilu Tang3Hai ZhangHai Zhang4Jinxin XuJinxin Xu5Sunkui KeSunkui Ke5*Jinbiao XieJinbiao Xie2*Rongyu XuRongyu Xu3*Ying ChenYing Chen4*Zhinuan HongZhinuan Hong1*Kang MingqiangKang Mingqiang1*
  • 1Fujian Medical University Union Hospital, Fuzhou, China
  • 2Affiliated Hospital of Putian University, Putian, Fujian Province, China
  • 3Quanzhou First Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
  • 4The People’s Hospital of Gaozhou, Gaozhou, China
  • 5Zhongshan Hospital, Xiamen University, Xiamen, Fujian Province, China

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Background: For esophageal squamous cell carcinoma(ESCC), neoadjuvant chemoimmunotherapy (nICT) constitute an innovative therapeutic strategy. However, The relationship between its short-term efficacy and long-term prognosis requires further clarification. Therefore, this study aims to evaluate the prognostic significance of major pathological response (MPR) in ESCC patients receiving nICT.Method: This is a retrospective multi-center study enrolling 306 ESCC patients undergoing nICT. The primary endpoints were recurrence-free survival (RFS) and recurrence patterns. Propensity score matching (PSM) was applied to address heterogeneity between groups. Kaplan-Meier curves and Cox regression analysis were utilized to analyze survival difference.Results: 144 achieved a MPR, while 68 achieved a pathological complete response (pCR). Cox regression analysis identified MPR as an independent prognostic factor [HR = 0.48, 95%CI= (0.28 -0.82), P = 0.007]. Survival analysis demonstrated that MPR patients experienced significantly improved RFS compared to non-MPR patients, before (P＜0.001) and after PSM (P = 0.016). Importantly, the RFS of MPR patients was comparable to that of pCR patients (P = 0.319 in the unmatched cohort ; P = 0.456 in the matched cohort). Furthermore, adjuvant therapy did not provide additional recurrence-free benefits for MPR patients. Compared to pCR patients, MPR patients exhibited a similar recurrence rate, with similar recurrence sites.undergoing nICT, demonstrating prognostic outcomes comparable to those of pCR.These findings indicated that MPR could function as a surrogate endpoint for pCR, potentially influencing treatment strategies by refining follow-up protocol and the implementation of adjuvant therapy.

Keywords: neoadjuvant chemoimmunotherapy, major pathological response, adjuvant therapy, Pathological complete response, Recurrence pattern

Received: 25 Mar 2025; Accepted: 13 Jun 2025.

Copyright: © 2025 Xie, Huang, Tang, Zhang, Xu, Ke, Xie, Xu, Chen, Hong and Mingqiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Sunkui Ke, Zhongshan Hospital, Xiamen University, Xiamen, 361004, Fujian Province, China
Jinbiao Xie, Affiliated Hospital of Putian University, Putian, 351100, Fujian Province, China
Rongyu Xu, Quanzhou First Hospital, Fujian Medical University, Quanzhou, 362000, Fujian Province, China
Ying Chen, The People’s Hospital of Gaozhou, Gaozhou, 525200, China
Zhinuan Hong, Fujian Medical University Union Hospital, Fuzhou, China
Kang Mingqiang, Fujian Medical University Union Hospital, Fuzhou, China

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