Abstract
BACKGROUND: Achieving pathological complete response (pCR) after neoadjuvant therapy is associated with improved survival in patients with esophageal squamous cell carcinoma (ESCC). However, the recurrence patterns and survival outcomes of pCR patients who received neoadjuvant chemotherapy (NAC), chemoradiotherapy (NCRT), or immunochemotherapy (NICT) remain unclear. METHODS: This retrospective cohort study included 250 ESCC patients who achieved pCR after neoadjuvant therapy (119 in the NAC group, 61 in the NCRT group, and 70 in the NICT group). The aim was to compare the effects of the three neoadjuvant modalities on recurrence patterns and overall survival (OS) in pCR patients. RESULTS: Under multimodal neoadjuvant therapy, there was no significant difference in recurrence rates among the three groups (NAC: 5.88% vs. NICT: 7.14% vs. NCRT: (9.84%,P = 0.624). Distant metastasis was the predominant pattern in the NAC (71.4%) and NCRT (80.0%) groups, while the NICT group exhibited a higher proportion of local recurrence (80.0%,P = 0.208); most recurrences occurred at a single site. The 5-year OS rates were 87.0% in the NAC group, 76.7% in the NCRT group, and not evaluable in the NICT group, with no statistical difference among groups (P = 0.189). Event-free survival (EFS) also showed no significant difference (P = 0.076). Intergroup differences were observed in the incidence of postoperative complications including Pneumonia (P < 0.05). CONCLUSION: No statistical differences in OS or EFS were found among pCR patients treated with different neoadjuvant modalities (P > 0.05), but recurrence patterns varied across groups: distant metastasis was more common in the NAC/NCRT groups, whereas the NICT group had a higher frequency of local recurrence. Multicenter long-term follow-up studies are warranted to validate these findings.