Abstract Background In recent years, immunotherapy as part of neoadjuvant treatment has been increasingly applied in the treatment of esophageal cancer, particularly in combination with chemotherapy, demonstrating a significant improvement in patient survival. However, whether patients require adjuvant therapy after neoadjuvant treatment remains unclear. Tumor regression grade (TRG) following neoadjuvant therapy reflects the individual response of the tumor to treatment, but its role in predicting the benefit of adjuvant therapy is not well understood. This study aims to investigate the role of TRG and other related factors in guiding postoperative adjuvant therapy. Methods This study included patients with thoracic esophageal squamous cell carcinoma who underwent R0 esophagectomy at three high-volume centers from January 2016 to December 2021. These patients received neoadjuvant treatment followed by esophagectomy. Tumor response was assessed based on TRG and classified into two groups: good responders (TRG 0–1) and poor responders (TRG 2–3). Survival analysis was performed using the Kaplan–Meier method. Results A total of 168 patients were included, with a median follow-up of 34 months. The 3-year survival rate of patients who received adjuvant therapy was 82.1%, compared to 69.5% in those who did not (p = 0.091). Subgroup analysis showed that among patients with TRG 0–1, the 3-year survival rate was 93.2% in the adjuvant therapy group, compared to 74.8% in the non-adjuvant therapy group (p = 0.022). Cox proportional hazards analysis indicated that adjuvant immunotherapy was associated with a reduced risk of death (HR, 0.23; 95% CI, 0.07–0.79; p = 0.02) in the TRG 0–1 subgroup. Additionally, yPN+ was independently associated with increased mortality (p = 0.016). Conclusion Adjuvant immunotherapy has a limited impact on overall survival in esophageal cancer patients, but it shows significant survival benefits in specific subgroups, particularly in patients with a good pathological response (TRG 0–1).
Huang et al. (Fri,) studied this question.