OA02.2. Survival Comparison in Patients With Pathological Complete Response Following Neoadjuvant Chemotherapy vs Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

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Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background In the treatment of esophageal squamous cell carcinoma (ESCC), previous studies have shown comparable overall survival (OS) between neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACRT). While NACRT typically yields a higher pathological complete response (pCR) rate, the reliability of pCR as a surrogate marker for survival remains a subject of debate. Furthermore, it is not clear if survival outcomes differ between these two preoperative approaches specifically among patients who reach pCR. Methods This study performed an integrated individual patient data (IPD) analysis using data from phase III clinical trials focused on resectable ESCC. The primary objective was to compare the prognostic outcomes of NAC versus NACRT, with a particular emphasis on the subgroup of patients who achieved pCR. Results Data from 1,044 patients (83.5% male; mean age 62.3 years) were pooled from seven randomized controlled trials across six countries. Of these, 605 patients underwent NAC and 439 received NACRT. The pCR rates were 6.9% and 34.2%, respectively. Notably, among the 192 patients who achieved pCR, the NAC group demonstrated a 5-year OS of 97.5%, compared to 70.4% in the NACRT group. Similarly, 5-year recurrence-free survival was higher for NAC (80.8%) than for NACRT (63.7%). Multivariable models confirmed that NAC was associated with a significant survival benefit in the pCR population. Conclusion Postoperative prognosis differs significantly by the type of neoadjuvant therapy, even when pCR is achieved. The exceptionally high survival rates seen in patients reaching pCR after NAC suggest that this specific group may be the most suitable candidates for exploring "watch-and-wait" strategies or the omission of surgery in future clinical trials.

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