Prognostic value of baseline tumour length in oesophageal squamous cell carcinoma patients treated with neoadjuvant immunochemotherapy.

INTRODUCTION

Neoadjuvant immunochemotherapy (nICT) is the standard treatment for locally advanced oesophageal squamous cell carcinoma (ESCC). The prognostic significance of the baseline tumour length (BTL) in patients treated with nICT followed by curative surgery remains unclear. This study evaluated the prognostic value of BTL.

METHODS

This single-centre, retrospective cohort study included 195 patients with cT2-4aN0-2M0 ESCC who underwent nICT and radical oesophagectomy. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal BTL cutoff value. Restricted cubic spline (RCS) modelling was used to explore the nonlinear association between BTL and survival.

RESULTS

The median follow-up duration was 46.4 months. ROC curve analysis identified 6.5 cm as an optimal BTL threshold for overall survival (OS) (P = 0.003). RCS modelling confirmed a nonlinear relationship between BTL and mortality risk, with the hazard ratio (HR) peaking at 7.5 cm. Patients with BTL ≥ 6.5 cm had inferior pathological responses and advanced postoperative pathology, alongside lower 4-year disease-free survival (DFS) (51.2% vs 65.4%, P = 0.022) and OS rates (52.2% vs 74.4%, P = 0.001). Multivariate Cox regression showed BTL ≥ 6.5 cm was independently associated with poorer OS (HR = 0.730, 95% confidence interval: 0.560-0.952, P = 0.020), while only a non-significant trend was observed for DFS.

CONCLUSION

BTL was independently associated with long-term OS in patients with ESCC who received nICT. As a readily available imaging variable, it may support postoperative risk stratification; however, it reflects a prognostic association rather than a validated predictive biomarker.