PD07.06. Lymphovascular and Perineural Invasion Identifies High-Risk Disease and Candidates for Postoperative Therapy After Neoadjuvant Immunochemotherapy in Esophageal Squamous Cell Carcinoma

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ID: 325961
2026
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Abstract
Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background Despite increasing use of neoadjuvant chemoimmunotherapy (nCIT) for locally advanced esophageal squamous cell carcinoma (ESCC), postoperative risk stratification remains suboptimal. Lymphovascular invasion (LVI) and perineural invasion (PNI) represent markers of aggressive tumor biology, yet their combined prognostic value and implications for adjuvant treatment in the nCIT setting have not been fully clarified. This study investigated the survival impact of concurrent LVI/PNI (defined as LNI) and explored its role in guiding postoperative therapeutic decisions. Methods We retrospectively evaluated 473 patients with ESCC who underwent nCIT followed by curative-intent resection. LVI and PNI were assessed on surgical specimens, and patients were categorized according to LNI status. Overall survival (OS), disease-free survival (DFS), and recurrence patterns were compared using propensity score matching and multivariable Cox regression to adjust for residual confounders. An independent external dataset was used for validation of prognostic associations and treatment interactions. Results LNI was identified in 21% of resected specimens. Patients with LNI exhibited significantly lower 3-year OS (49.8% vs 76.4%) and DFS (41.7% vs 69.3%) compared with LNI-negative counterparts, differences that persisted after matching and multivariable adjustment. LNI independently predicted worse OS (HR 1.52; P = 0.022) and DFS (HR 1.40; P = 0.045). Recurrence was more frequent among LNI-positive patients (39.4% vs 19.8%), with a predominance of locoregional failure. Importantly, in the LNI-positive subgroup, receipt of adjuvant therapy was associated with substantial improvement in 3-year OS (56.8% vs 32.4%) and DFS (49.7% vs 20.7%), corresponding to a significant reduction in mortality risk (adjusted HR 0.43; P = 0.002). External validation confirmed both the independent adverse prognostic impact of LNI and the survival benefit conferred by adjuvant therapy in this high-risk population. Conclusion The coexistence of lymphovascular and perineural invasion after nCIT delineates a biologically aggressive ESCC phenotype with high recurrence risk and inferior survival. However, these patients appear to derive meaningful benefit from postoperative adjuvant therapy. Incorporation of LNI status into postoperative risk assessment may facilitate precision-guided adjuvant treatment strategies in the contemporary immunochemotherapy era.
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Authors Taidui Zeng, Yizhou Huang, Maohui Chen, Chun Chen, Bin Zheng
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.128
URL
https://doi.org/10.1093/dote/doag077.128
Keywords Keywords not found

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