Retrospective study of prognostic significance of lymphovascular and perineural invasion after neoadjuvant chemoimmunotherapy in ESCC

Lymphovascular (LVI) and perineural invasion (PNI) are adverse pathological features in esophageal squamous cell carcinoma (ESCC). A retrospective study at Fujian Medical University Union Hospital (Fuzhou, China) evaluated the prognostic significance of combined LVI/PNI (LNI) after neoadjuvant chemoimmunotherapy (nCIT) and the potential benefit of adjuvant therapy in ESCC. The analysis included 473 ESCC patients undergoing nCIT followed by curative resection. LNI was present in 21% of patients. LNI-positive patients had worse 3-year overall survival (OS; 49.8% versus 76.4%) and disease-free survival (DFS; 41.7% versus 69.3%) rates, differences that remained significant after propensity score matching. LNI independently predicted inferior OS (HR 1.52; p=0.022) and DFS (HR 1.40; p=0.045). Recurrence occurred more frequently in LNI-positive patients (39.4% versus 19.8%; p<0.001). Among LNI-positive patients, adjuvant therapy improved 3-year OS (56.8% versus 32.4%) and DFS (49.7% versus 20.7%) rates. External validation using an independent patient-level dataset confirmed these findings. The authors conclude that LNI after nCIT is an independent adverse prognostic factor in ESCC. LNI-positive patients derive significant benefit from adjuvant therapy (graphical abstract).