Predictors of overall survival in esophageal cancer patients with pathologic complete response after neoadjuvant therapy and surgery

Summary Esophageal cancer recurrence occurs even in those who have a pathologic complete response (pCR) following neoadjuvant therapy and esophagectomy. The purpose of this study is to identify predictors of overall survival in patients with pCR. Using the National Cancer Database, a retrospective analysis of all adult patients with ypT0N0 esophageal cancer following neoadjuvant chemotherapy and radiation between 2012 and 2020 was performed. The variables analyzed were age, gender, ethnicity, insurance, Charlson–Deyo comorbidity score, clinical stage, and facility type. Cox proportional hazards regression was used to identify predictors of overall survival. Wilcoxon rank sum and chi-square tests were used for continuous and categorical variables, respectively, with a significance level of P < 0.05. There were 2767 patients that met the inclusion criteria, with the mean age of 63; 78% were male and 92% were White. Median survival was 6.6 years (95% confidence interval [CI]: 6.21–7.12). In multivariable analysis, older age (hazard ratio [HR] 2.7 per year, P < 0.0001), male gender (HR 3.3, P = 0.02), Charlson–Deyo score ≥ 2 (HR 3.9, P = 0.01), and advanced clinical stage (Stage IV vs. Stage I, HR 21.93, P < 0.001) predicted worse overall survival. Among patients who achieved pCR, advanced age, male gender, comorbidities, and clinical stage significantly influenced survival. Tumor- and treatment-related factors that impacted overall survival are advanced clinical stage and treatment at community facilities. These findings suggest that patients with advanced-stage esophageal cancer who achieve pCR remain at higher risk for recurrence and future studies should investigate this population further.