455. RADIOLOGICAL TUMOR VOLUME AS A PREDICTOR OF OUTCOMES IN PATIENTS TREATED WITH NEOADJUVANT THERAPY AND SURGERY FOR ADVANCED ESOPHAGEAL CANCER

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Abstract Background The association between pretreatment esophageal tumor volume and disease-free survival (DFS) and overall survival (OS) in patients who underwent neoadjuvant therapy followed by surgery is not extensively studied. Methods We analyzed data from a prospectively maintained database of patients with locally advanced esophageal cancer treated with neoadjuvant therapy and surgery at a tertiary care center over six years (2014–2020). Pretreatment CT scans were retrieved from the hospital’s Picture Archiving and Communication System (PACS), and tumor volumes were calculated manually using a mapping method. Survival data, including OS (overall survival) and DFS (disease-free survival), were obtained from the hospital-based cancer registry and patient records. Results Among the 69 patients included in the analysis, univariate analysis showed no statistically significant association between tumor volume and OS (p = 0.134) or DFS (p = 0.969). Multivariate analysis revealed a statistically significant association between tumor volume and DFS (p = 0.010). When tumor volumes were categorized into two groups based on the ROC curve method (<22.77 mL/≥22.77), median difference of 10 months in OS and mean difference of 10 months in DFS was observed between the groups. Though these differences may not be statistically significant, they may hold clinical significance in patients with locally advanced esophageal carcinoma. Conclusion Pretreatment CT-derived tumor volume appears to be a promising prognostic indicator in patients with esophageal cancer treated with neoadjuvant therapy followed by surgery. While univariate analysis did not show a significant association with overall survival (OS) or disease-free survival (DFS), multivariate analysis identified a significant link between lower tumor volume and improved DFS. Stratifying tumor volumes using ROC-derived cutoffs (<22.77 mL vs. ≥22.77 mL) revealed clinically meaningful differences in survival outcomes. Although not statistically significant for OS, the trend suggests potential prognostic value. Larger, prospective studies are required to confirm these findings and establish clinical relevance in routine practice.

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