Survival of esophageal squamous cell carcinoma achieving pathological complete response after neoadjuvant immunochemotherapy

Abstract Background Immunochemotherapy is increasingly adopted as neoadjuvant regimen for locally advanced esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the survival outcomes for those who achieved pathological complete response (pCR) following immunochemotherapy. Methods From January 2020 and June 2025, 154 patients who achieved pCR after neoadjuvant immunochemotherapy were included for this analysis. We documented baseline patient characteristics, assessed survival outcomes, and designated disease-free survival (DFS) as the primary endpoint. Results Of the 154 patients, there were 47 (30.5%) patients received chemotherapy combined with pembrolizumab, 37 (24.0%) with tislelizumab, 31 (20.1%) with sintilimab, 26 (16.9%) combined with camrelizumab, and 13 (8.4%) with other immune checkpoint inhibitors. Majority of the patients (74.1%, 114/154) had two treatment cycles. There were 81 patients (52.6%) underwent McKeown procedure and 73 (47.4%) underwent Ivor Lewis procedure, with the median of 30 lymph nodes resected. After a median follow-up of 25 months, the 1-year and 3-year DFS were 97% and 78%, respectively, the 1-year and 3-year overall survival were 97% and 88%, respectively. Advanced clinical tumor stage (hazard ratio [HR] = 4.831, 95% confidence interval [CI] 1.748–13.347, P = 0.002), more than two treatment cycles, (HR = 3.449, 95% CI 1.168–10.179, P = 0.025), and a treatment-to-surgery less than 6 weeks (HR = 5.344, 95% CI 1.198–23.840, P = 0.028) were associated with reduced DFS. Conclusion ESCC patients achieving pCR after immunochemotherapy had favorable survival outcomes, yet disease recurrence remains a notable concern. Advanced tumor stage, increased number of treatment cycles and shortened interval between neoadjuvant treatment and surgery were associated with compromised survival in this patient population. These exploratory findings may help guide future prospective studies.