Tumor volume change rate based on three-dimensional reconstruction as a predictor of pathological response and survival prognosis in esophageal squamous cell carcinoma with neoadjuvant immunochemotherapy

BACKGROUND: This research aimed to explore the significance of tumor volume change rate (TVCR) in predicting pathological response and survival prognosis for esophageal squamous cell carcinoma receiving neoadjuvant immunochemotherapy. METHODS: Esophageal squamous cell carcinoma patients receiving neoadjuvant immunochemotherapy followed by esophagectomy between October 2020 and March 2024 were reviewed. The TVCR was measured and calculated through three-dimensional reconstruction based on computed tomography images. Pathological response, operative characteristics, postoperative complications were compared between the group with TVCR ≤ 45% and the group with TVCR > 45% using chi-square test or independent sample t-test. The receiver operating characteristic curve and area under the curve (AUC) were employed to determine the efficacy of TVCR in predicting pathological response. The overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method with log-rank test. The univariate and multivariate Cox regression models were performed to identify the independent prognostic factors. RESULTS: A total of 120 esophageal squamous cell carcinoma patients receiving neoadjuvant immunochemotherapy were enrolled. The group with TVCR > 45% had significantly more cases achieving major pathological response (MPR) compared to the group with TVCR ≤ 45% (49.2% vs. 27.3%, P = 0.014). The TVCR outperformed Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria in predicting MPR (AUC, 0.614 vs. 0.574). Patients with TVCR > 45% had better 3-year OS (88.7% vs. 60.7%, P < 0.001) and DFS rates (76.8% vs. 49.8%, P < 0.001) compared to those with TVCR ≤ 45%. Additionally, TVCR was determined as an independent prognostic factor for OS and DFS in esophageal squamous cell carcinoma receiving neoadjuvant immunochemotherapy. CONCLUSIONS: The TVCR can serve as a predictor for pathological response and survival prognosis in esophageal squamous cell carcinoma treated with neoadjuvant immunochemotherapy.