Predicting the Efficacy of Neoadjuvant Chemotherapy Combined with Immunotherapy for Esophageal Squamous Cell Carcinoma via Enhanced CT Radiomics Combined with Clinical Features

Introduction To evaluate the predictive efficacy of enhanced Computed Tomograph(CT) radiomics combined with clinical features for assessing treatment response to neoadjuvant chemotherapy plus immunotherapy in esophageal squamous cell carcinoma (ESCC) patients. Methods We retrospectively analyzed 189 pathologically confirmed esophageal squamous cell carcinoma patients (treated between January 2020 and October 2024) who underwent neoadjuvant chemoimmunotherapy. Patients were stratified into remission and non-remission groups based on pathological response and randomly divided into training (n = 114) and testing (n = 75) sets (6:4 ratio). Clinical predictors were identified using logistic regression to construct a clinical model. Radiomic features were extracted from manually delineated tumor regions on contrast-enhanced CT scans, and a radiomics model was developed. A combined model integrating clinical variables and radiomics probabilities was then built and presented as a nomogram. Model performance was assessed using receiver operating characteristic (ROC) curves (AUC, Area Under the Curve) comparison via Delong test), calibration curves, and decision curve analysis (DCA). Results Multivariable analysis identified treatment cycle number as a significant clinical predictor. Ten radiomic features were selected for the final model. In the training set, the clinical model achieved an AUC of 0.705 (95% CI 0.607-0.802), while the radiomics and combined models showed superior performance with AUCs of 0.905 (95% CI 0.843-0.967) and 0.914 (95% CI 0.857-0.970), respectively. Similar trends were observed in the testing set, where the combined model (AUC 0.859, 95% CI 0.768-0.950) outperformed both the radiomics (AUC 0.815) and clinical (AUC 0.644) models. Conclusion The enhanced CT radiomics model has better predictive efficacy for remission with neoadjuvant chemotherapy combined with immunotherapy in esophageal squamous cell carcinoma patients, and the combined model has greater predictive value.