Vasculogenic mimicry triggers early recidivation and resistance to adjuvant therapy in esophageal cancer

Abstract Objective: This study aimed to investigate the impact of vasculogenic mimicry (VM) and postoperative adjuvant therapy on the prognosis and survival of patients with esophageal squamous cell carcinoma (ESCC), as well as to assess whether VM affects the clinical benefit of postoperative adjuvant therapy. Methods: A single-center retrospective analysis was conducted on patients who underwent radical surgery for squamous esophageal cancer, documented in the medical record system. The presence or absence of VM in surgical specimens was determined using double staining with PAS/CD31. Stratification was applied based on adjuvant therapy and VM status. Survival curves and COX modelling were used to analyze the impact of the presence or absence of VM on the benefit of adjuvant therapy and survival prognosis of patients. Results: VM-positive patients were more prone to postoperative recurrence and metastasis. VM was identified as an independent risk factor for progression-free survival (p<0.001, 95% CI:1.809-3.852) and overall survival (p<0.001, 95% CI:1.603-2.786) in postoperative squamous esophageal cancer. Postoperative adjuvant therapy significantly prolonged progression-free survival (p=0.008) and overall survival time (p<0.001) in patients with stage II and III esophageal cancer, with concurrent chemoradiotherapy being the most effective. However, the presence of VM significantly reduced the benefit of postoperative adjuvant therapy (p＝0.152). Conclusion: VM negatively impacts the prognosis of postoperative ESCC patients and reduces the efficacy of postoperative adjuvant therapy.