P1.057. Early Recurrence After Neoadjuvant Therapy and Esophagectomy for Locally Advanced ESCC

Abstract

Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background Despite improved interventions with radical esophagectomy accompanied by perioperative systematic therapy, recurrence remains frequent in locally advanced esophageal squamous cell carcinoma (ESCC). A clinically important subset experiences early recurrence (ER), which is often followed by rapid deterioration and limited opportunities for effective salvage therapy. Identifying patients at high risk of ER and understanding the dominant failure patterns may inform postoperative surveillance intensity and risk-adapted adjuvant strategies. We aimed to determine clinicopathologic predictors of ER and to characterize recurrence patterns after curative resection. Methods We retrospectively analyzed a prospectively maintained cohort of patients with locally advanced ESCC treated with neoadjuvant chemotherapy (nCT) or chemoradiotherapy (nCRT) followed by curative esophagectomy. ER was defined as any recurrence within 12 months after surgery, non-ER comprised patients recurring later or remaining recurrence-free. Clinicopathologic characteristics were compared between groups. Factors associated with ER were ssessed using Cox regression, and recurrence patterns were compared using categorical models. Results Among 517 patients, 238 (46.0%) developed recurrence, and 126/238 (52.9%) occurred within 12 months. Univariable predictors of ER included comorbidity (HR=1.356; p=0.049), pathologic regression (HR=0.506; p=0.006 for complete; HR=0.572; p=0.001 for major), invasion depth (HR=0.543; p=0.001), lymph-node invasion (HR=2.380; p<0.001), and tumor deposits (HR=2.368; p<0.001). Female sex showed borderline significance (HR=0.584; p=0.053). Multivariable analysis identified major pathologic regression (HR=0.741; p=0.089), lymph-node invasion (HR=2.000; p<0.001), and tumor deposits (HR=1.656; p=0.021) as independent predictors for ER. ER was more often distant than locoregional (RR=1.70; p=0.07). Non-ER patients had markedly better overall survival (HR=0.102; p<0.001), most evident within 24 months. Conclusion Early recurrence within 12 months after neoadjuvant therapy and curative esophagectomy is common in locally advanced ESCC and is independently associated with treatment response, lymph-node involvement, and tumor deposits. ER shows a tendency toward distant failure and confers substantially worse early postoperative survival. supporting intensified surveillance and risk-adapted postoperative strategies.