OA02.4. Pathologic Response Predicts Survival After Neoadjuvant Chemotherapy for Esophageal Adenocarcinoma: A Propensity-Matched Analysis

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ID: 326057
2026
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Abstract
Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background Perioperative chemotherapy (CT) is increasingly replacing chemoradiotherapy (CRT) for the treatment of esophageal adenocarcinoma, although CRT is associated with higher rates of pathologic complete response (pCR). Whether degree of pathologic regression, beyond binary pCR status, independently predicts survival and whether treatment strategy modifies this relationship remain unclear in real-world practice. Methods We retrospectively analyzed adults with resectable locally advanced esophageal or gastroesophageal junction adenocarcinoma who underwent esophagectomy (January 2013 to October 2024) following induction CRT or perioperative CT ± immunotherapy (IO). To address baseline imbalances, propensity-score matching (1:1) was performed. Disease-free survival (DFS) was estimated using Kaplan-Meier methods and compared with log-rank tests. In the full unmatched cohort, percent pathologic tumor regression was modeled as a continuous variable in multivariable Cox regression to assess its independent association with overall survival (OS) and to test for interaction with treatment strategy. All analyses were performed using R version 4.5.0. Results Among 811 patients (CRT, n=650; CT ± IO, n=161), median follow-up was 29.9 months. CRT was associated with a higher rate of pCR (23% vs 14%; p=0.013) and ypN0 (61% vs 46%; p<0.001). In the full cohort (n=811), each 10% increase in pathologic tumor regression was independently associated with longer OS (hazard ratio, 0.89 [95% confidence interval, 0.84-0.94]; p<0.001); this was consistent across treatment groups (interaction p=0.230) (Figure 1). In the propensity-matched cohort (n=294), baseline characteristics were well balanced. There was no difference in OS between CT ± IO and CRT (p=0.097). Among patients without pCR, DFS was significantly longer with CT ± IO (p=0.027); DFS was not statistically different among patients with pCR (p=0.18) (Figure 2). Conclusion Degree of pathologic regression is independently associated with survival; this finding supports a graded prognostic effect beyond binary pCR status. Perioperative CT ± IO was associated with longer DFS, compared with CRT, in patients without pCR. These findings suggest that locoregional response alone does not fully capture treatment benefit and support the hypothesis that systemic therapy–intensified strategies may enhance micrometastatic control.
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Authors Nianye Zhang, Aroub Alkaaki, Siqi Chen, B. J. Park, David Jones, Katherine Gray, Matthew Bott, Smita Sihag, Daniela Molena
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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/doag077.016
URL
https://doi.org/10.1093/dote/doag077.016
Keywords Keywords not found

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