The predictive role of hematologic indicators in locally advanced esophageal squamous cell carcinoma patients receiving neoadjuvant chemoimmunotherapy

Abstract

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 followed by curative esophagectomy were retrospectively analyzed. Baseline and preoperative hematologic indices were collected to calculate neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and C-reactive protein-to-albumin ratio (CAR). Logistic regression factors identified associated with pCR, and a nomogram was developed and internally validated. Kaplan-Meier analysis and Cox regression analyses were performed for disease-free survival (DFS) and overall survival (OS).

Results: Among the 204 patients, 59 achieved pCR, with a pCR rate of 28.9%. Multivariate logistic regression identified lower baseline NLR, lower preoperative NLR, lower preoperative CAR, earlier clinical Tumor-Node-Metastasis stage, and better tumor differentiation were independently associated with pCR. The nomogram showed good discrimination with a concordance index (C-index) of 0.816 and a bootstrap-corrected C-index of 0.792. In multivariate Cox analysis, low baseline NLR, female, and pCR were associated with longer DFS, while low baseline NLR and pCR were associated with prolonged OS.

Conclusion: Lower NLR and CAR were associated with improved pathological response and survival outcomes. The nomogram may serve as a convenient adjunctive tool for individualized pCR prediction, but external validation is required.

Keywords

Neoadjuvant immunochemotherapy / esophageal squamous cell carcinoma / hematologic biomarkers / pathological complete response / nomogram

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