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Efficacy evaluation and prognostic prediction of endoscopic ultrasound for neoadjuvant immunotherapy in esophageal cancer

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Abstract

Background and objectives

Neoadjuvant immunotherapy combined with chemotherapy or chemoradiotherapy has emerged as a promising approach in the treatment of esophageal cancer. However, there is a lack of comprehensive understanding regarding the clinical factors that can predict patient response to this therapy. The aim of this study was to develop a predictive model for assessing the efficacy of neoadjuvant immunotherapy in patients undergoing surgical treatment.

Methods

This study retrospectively enrolled 220 consecutive patients with preoperative immunotherapy combined chemotherapy or chemoradiotherapy. A logistic regression was used to evaluate the association between pathologic complete response (pCR) and endoscopic ultrasound parameters, constructing a predictive model for treatment response. Additional, overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method, and Cox regression analyses were introduced to explore the associations between EUS factors after neoadjuvant immunotherapy.

Results

Logistic regression analysis identified that the significant predictors of pCR were treatment regimen, negative biopsy findings, RECIST assessment, endoscopic ultrasound responder, and downstaging in uN. A predictive model including above five variables was generated, and area under the curve was 0.840(95%CI 0.78–0.89), this nomogram was also adequately validated internally. In the cox regression analyses, EUS responder was found to be a significant predictor of overall survival with a hazard ratio (HR) of 0.38(95%CI 0.15–0.98), whereas only pCR status was a significant predictor of PFS (HR 0.80; 95%CI 0.01–0.60).

Conclusions

EUS responder can serve as a valuable predictor of the efficacy of adjuvant immunotherapy combined with chemotherapy or chemoradiotherapy, as well as of survival outcomes.

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Data availability

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

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Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, People’s Republic of China

    Qiao-na Liu, Yu-fan Chen, Guang-yu Luo & Xu Zhang

  2. Department of Endoscopy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People’s Republic of China

    Qiao-na Liu, Yu-fan Chen & Guang-yu Luo

  3. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People’s Republic of China

    Xu Zhang

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Correspondence to Guang-yu Luo or Xu Zhang.

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Disclosures

Qiao-na Liu, Yu-fan Chen, Guang-yu Luo, and Xu Zhang have no conflicts of interest or financial ties to disclose.

Ethical approval

This was a retrospective study based on clinical data and was performed according to an institutional review board agreement under the authority of the Sun-Yat-sen University Cancer Hospital (Approval No. B2024-771-01). The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a prior approval by the institution’s Human Research Committee.

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Supplementary Information

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Supplementary file1 (TIF 19812 KB)

Supplement Figure 1. The ROC curve of EUS-derived maximum tumor thickness shrinkage rate.

Supplementary file2 (TIF 17687 KB)

Supplement Figure 2. The ROC curve of pretreatment EUS-derived maximum tumor thickness.

Supplementary file3 (TIF 16873 KB)

Supplement Figure 3. The ROC curve of post-treatment EUS-derived maximum tumor thickness.

Supplementary file4 (TIF 830 KB)

Supplement Figure 4. Kaplan–Meier curves depicting the assessment based by RECIST criteria and restaging in uN on PFS and OS for patients without adjuvant therapy.

Supplementary file5 (TIF 16728 KB)

Supplement Figure 5. Kaplan–Meier curves depicting the biopsy finding on PFS and OS for patients without adjuvant therapy.

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Liu, Qn., Chen, Yf., Luo, Gy. et al. Efficacy evaluation and prognostic prediction of endoscopic ultrasound for neoadjuvant immunotherapy in esophageal cancer. Surg Endosc (2025). https://doi.org/10.1007/s00464-025-11728-y

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