The Predictive Role of Hematologic Indicators in locally Advanced Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Chemoimmunotherapy

Aim: Neoadjuvant immunochemotherapy (nICT) has shown promising efficacy in locally advanced esophageal squamous cell carcinoma (LA-ESCC), but reliable predictors of pathological response and prognosis remain lacking. This study aimed to evaluate the predictive value of hematologic indicators for pathological complete response (pCR) and survival outcomes in LA-ESCC patients treated with nICT. Methods: A total of 204 LA-ESCC patients who received nICT were retrospectively analyzed. Baseline and preoperative hematologic indices were collected to calculate neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and C-reactive protein-to-albumin ratio (CAR). Logistic regression identified predictors of pCR, and a nomogram was developed and internally validated. Kaplan-Meier analysis and Cox regression analyses were conducted to assess predictors of disease-free survival (DFS) and overall survival (OS). Results: Multivariate logistic regression identified lower baseline NLR (p = 0.014), lower preoperative NLR (p = 0.006), lower preoperative CAR (p = 0.037), earlier clinical Tumor-Node-Metastasis (cTNM) stage (p = 0.024), and better tumor differentiation (p = 0.006) as independent predictors of achieving pCR. The nomogram showed good discrimination with a concordance index (C-index) of 0.816 (95% confidence interval [CI]: 0.755-0.877) and a bootstrap-corrected C-index of 0.792. In multivariate Cox analysis, low baseline NLR (p = 0.047), female (p = 0.034), and pCR (p = 0.001) independently predicted longer DFS, while low baseline NLR (p = 0.036) and pCR (p = 0.046) independently predicted prolonged OS. Conclusion: Hematologic markers, particularly NLR and CAR, are valuable predictors of both pathological response and prognosis in LA-ESCC patients receiving nICT.