Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Postoperative adjuvant PD-1 immunotherapy survival and body-mass-index dynamics in esophageal cancer: A real-world retrospective study
Liu-Yu Li, Mei-Qing Zhang, Wen-Min Ying, Wen-Zhen Zhang, Wei-Jing Jiang, Ting-Jie Xiong, Feng-Mei Wang, Zhi-Chao Fu
Liu-Yu Li, Wei-Jing Jiang, Ting-Jie Xiong, Department of Radiotherapy, Fuzong Clinical Medical College (900th Hospital), Fujian Medical University, Fuzhou 350025, Fujian Province, China
Mei-Qing Zhang, Department of Thoracic and Cardiac Surgery, Fuzong Clinical Medical College (900th Hospital), Fujian Medical University, Fuzhou 350025, Fujian Province, China
Wen-Min Ying, Department of Radiotherapy, Fuding Hospital, Fuding 355200, Fujian Province, China
Wen-Zhen Zhang, Department of Radiotherapy, Fuzong Clinical Medical College (900th Hospital), Fuzhou 350025, Fujian Province, China
Feng-Mei Wang, Department of Obstetrics and Gynecology, Fuzong Clinical Medical College (900th Hospital), Fujian Medical University, Fuzhou 350025, Fujian Province, China
Zhi-Chao Fu, Department of Radiotherapy, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou 350112, Fujian Province, China
Co-first authors: Liu-Yu Li and Mei-Qing Zhang.
Co-corresponding authors: Feng-Mei Wang and Zhi-Chao Fu.
Author contributions: Fu ZC, Li LY and Wang FM concepted and designed the study. Data collection was done by Jiang WJ and Zhang WZ. Formal analysis was done by Li LY, Zhang MQ, Ying WM and Xiong TJ. All authors have read and approved the final manuscript. Both Fu ZC and Wang FM have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Fu ZC applied for and obtained the funds for this research project. He searched the literature, revised and submitted the early version of the manuscript with the focus on Prognosis of surgical immunotherapy for esophageal cancer. Fu ZC conceptualized, designed, and supervised the whole process of the project. Wang FM was instrumental and responsible for data re-analysis and re-interpretation, figure plotting, comprehensive literature search, preparation. This collaboration between Fu ZC and Wang FM is crucial for the publication of this manuscript and other manuscripts still in preparation.
Supported by Wu Jieping Medical Foundation, No. 320.6750.2024-16-28.
Institutional review board statement: The study protocol was approved by the 900th Hospital of the China Joint Logistics Force Biomedical Research Ethics Committee, No. 2024-032.
Informed consent statement: This is a retrospective clinical study and the data were obtained from medical records and data from the hospital medical record system. It does not involve the identity or privacy of the subjects, nor does it pose any risk or harm to the subjects, and therefore informed consent is exempted.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Zhi-Chao Fu, Department of Radiotherapy, Fuzong Clinical Medical College of Fujian Medical University, No. 156 West Second Ring Road North, Fuzhou 350112, Fujian Province, China.
fauster1112@126.com
Received: April 22, 2025
Revised: May 17, 2025
Accepted: July 14, 2025
Published online: August 15, 2025
Processing time: 114 Days and 23.8 Hours
BACKGROUND
Esophageal cancer (EC), primarily esophageal squamous cell carcinoma in China, has a poor prognosis with a 5-year survival rate of approximately 25% after surgery alone. Neoadjuvant chemoradiotherapy combined with surgery is the standard treatment for locally advanced EC, with a 47% 5-year survival rate, although adverse events are common. Immunotherapy, particularly PD-1 inhibitors, has shown promise in treating advanced EC, and neoadjuvant chemotherapy with immunotherapy is effective. However, the efficacy of postoperative immunotherapy remains unclear, with studies like Checkmate577 showing promising results but limited applicability to surgery-only patients, highlighting the need for further research.
AIM
To evaluate the efficacy, prognostic factors, and safety of adjuvant immunotherapy with anti-PD-1 inhibitors following radical surgery for EC.
METHODS
A retrospective analysis was conducted on EC patients who received adjuvant immunotherapy after radical treatment at the 900th Hospital of the China Joint Logistics Force between January 2018 and October 2024. Demographic, treatment and laboratory data were collected. Progression-free survival (PFS) was assessed using the Kaplan-Meier method, and independent prognostic factors were identified using Cox regression. Optimal cutoff values for continuous variables, including body mass index (BMI) difference and neutrophil-to-lymphocyte ratio (NLR), were determined using the maxstat package in R.
RESULTS
A total of 44 patients were included, with a 2-year PFS rate of 68.6% [95% confidence interval (CI): 53%-88.7%]. Univariate analysis identified several factors significantly associated with prognosis, including the interval between surgery and immunotherapy, BMI difference between before surgery and first immunotherapy, presurgical lymphocyte count, and presurgical NLR. Multivariable Cox regression revealed that a BMI difference < 3.86 was an independent protective factor for PFS (hazard ratio: 0.42, 95%CI: 0.21-0.85, P < 0.05). At the last follow-up, the median PFS for patients with BMI < 3.86 had not been reached, compared to 8.83 months for those with BMI > 3.86. The 1-year PFS for patients receiving postoperative chemotherapy combined with immunotherapy was 88.5%, suggesting superior efficacy over chemotherapy alone.
CONCLUSION
Adjuvant immunotherapy for EC shows good efficacy and safety. A BMI difference < 3.86 is a protective factor for PFS, highlighting the importance of monitoring nutrition and inflammation for personalized treatment.
Core Tip: This single-center, retrospective real-world study investigated the efficacy of adjuvant PD-1 immunotherapy following radical surgery for esophageal cancer and identifying related prognostic factors. A literature review published in the past 5 years on PubMed revealed no existing studies on this topic, making this research innovative. Additionally, the study found that the difference in body mass index (BMI) between the preoperative period and initiation of the first immunotherapy session serves as an independent prognostic factor. Specifically, a BMI difference < 3.86 was associated with better prognosis, providing valuable insights for guiding personalized follow-up treatment.
