Pathological response is an important marker for tumor aggressiveness in patients with esophageal squamous cell carcinoma (ESCC) who receive preoperative chemoradiation followed by esophagectomy. We aim to evaluate the prognostic value of histological factors after trimodality treatments. 91 patients who received preoperative chemoradiation followed by transthoracic esophagectomy between 2009 and 2014 were included. The pathological examination was reviewed. Overall survival and disease free survival were recorded. Survival analysis was performed using the Cox regression model, and the survival curves were compared by the log-rank test. Survival analysis showed lymphovascular invasion (LVI, hazard ratio [HR]: 2.009, p = 0.029), perineural invasion (PNI, HR: 2.226, p = 0.019), ypN stage (HR: 2.041, p = 0.019), extracapsular invasion (ECI, HR: 2.804, p = 0.003), and incomplete resection (HR: 1.897, p = 0.039) as unfavorable prognostic factors affecting overall survival (OS). Moreover, tumor regression grade (TRG, HR: 1.834, p = 0.038), LVI (HR: 1.975, p = 0.038), ECI (HR: 2.836, p = 0.003), and incomplete resection (HR: 2.254, p = 0.007) adversely affected disease-free survival (DFS). Prognostic classification based on poor primary tumor (TRG2/3, LVI(+), and PNI (+)), lymph node (ypN(+) and ECI(+)), and surgical (incomplete resection) factors significantly predicts OS (p = 0.013) and DFS (p = 0.017). However, the use of postoperative adjuvant therapy was not a significant prognostic factor even in medium- and high-risk ESCC patients who underwent trimodality treatments. Histological factors, including primary tumor, lymph node, and surgical factors has high prognostic value for predicting outcomes in ESCC patients receiving preoperative chemoradiation followed by surgery.

Background: The impact of delayed surgery on clinical outcomes after histologic or radiologic diagnosis of clinical stage I adenocarcinoma remains controversial. We evaluated the effects of delayed surgery on outcomes of patients with early-stage lung cancer. Methods: Associations between time intervals of “histologic diagnosis-to-surgery” (HDS), “radiologic diagnosis-to-surgery” (RDS), and overall survival in clinical stage I adenocarcinoma were assessed using multivariable Cox proportional hazard analysis. Results: A total of 561 consecutive patients with preoperative histologic confirmation of stage I lung cancer between 2006 and 2016 were included. Median time to HDS and RDS were 20 (2–267) and 58 (38–2,983) days. Higher Charlson comorbidity score, receiving brain magnetic resonance imaging screening, and video-assisted thoracoscopic surgery approach were significantly associated with increased risk of late HDS (>21 days). Smaller tumor size and non-radiologic solid-dominant pattern were significantly associated with increased risk of late RDS (>60 days). In the overall cohort, worse 5-year overall survival was associated with late HDS compared to early HDS (75.9% vs. 85.5%, P=0.003). No significant differences were found in later late vs. early RDS (83.7% vs. 83.3%, P=0.570). In 286 propensity-score matched patients, late HDS [adjusted hazard ratio (aHR) =2.031, P=0.038], higher Charlson comorbidity score (aHR=1.610, P=0.023), larger tumor size (aHR=2.164, P=0.031), without brain magnetic resonance imaging screening (aHR=2.051, P=0.045), and tumor with angiolymphatic invasion (aHR=4.638, P=0.001) were significantly associated with lower overall survival. Conclusions: In patients with stage I lung adenocarcinoma, delayed surgery after a histologic diagnosis is an independent predictor of overall survival after adjusting for clinical risk factors, suggesting meaningful differences in clinical outcomes between timely vs. delayed surgeries.

The CheckMate 577 trial demonstrated that adjuvant nivolumab improves disease-free survival in patients with resected esophageal cancer following neoadjuvant chemoradiotherapy. This study aimed to evaluate real-world outcomes associated with adjuvant immunotherapy. Patients with esophageal cancer and residual pathological disease who underwent neoadjuvant therapy followed by surgical resection between January 2019 and February 2024 were retrospectively analyzed. Participants were grouped by adjuvant treatment received: no adjuvant therapy, adjuvant immunotherapy (AI), or adjuvant chemotherapy (AC). Primary outcomes included overall survival (OS) and recurrence-free survival (RFS). Subgroup analyses were performed for patients meeting CheckMate 577 eligibility criteria and those with pathological node-positive (ypN+) status. The study included 127 patients (mean age: 60 years; male: 86%): 23 received AI, 36 AC, and 68 received no adjuvant therapy. There were no significant differences in OS between AI and AC groups (median OS [mOS]: 34 months vs. 34 months; p=0.81), nor in RFS (median RFS [mRFS]: 15 months vs. 16 months; p=0.94). In the CheckMate 577-eligible subgroup (n=68), OS and RFS were similar between AI and AC groups (mOS: 25 months vs. 47 months; p=0.16; mRFS: 19 months vs. 20 months; p=0.74). Likewise, among ypN+ patients (n=54), no significant differences in OS or RFS were noted between AI and AC (mOS: 34 months vs. 31 months; p=0.74; mRFS: 9.5 months vs. 14 months; p=0.89). AI did not demonstrate a significant survival advantage compared to AC, even in patients meeting CheckMate 577 criteria or those with ypN+ status. Identifying the optimal adjuvant treatment for esophageal cancer remains a challenging and evolving issue.