{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:02:08Z","timestamp":1787238128746,"version":"build-2736575974"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To develop a prognosis nomogram for locally advanced esophageal squamous cell carcinoma (LA-ESCC) patients after neoadjuvant immunochemotherapy (NICT) and assess postoperative adjuvant therapy (PAT) value through survival risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 297 LA-ESCC patients (2019\u20132023) receiving NICT with or without PAT, randomly divided into the training and validation cohorts. Independent prognostic factors were determined by Least Absolute Shrinkage and Selection Operator (Lasso) regression and multivariate Cox analysis. Progression-free survival (PFS) was compared by the Kaplan-Meier analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median follow-up time after surgery was 31.67 months (2.23-62.5 months) as of January 25, 2025. The 1-year and 2-year PFS rates were 82.8% and 67.8%. The analysis identified tumor length, tumor thickness reduction rate, surgical method, number of lymph nodes dissected, and ypN-stage as independent prognostic factors. In the training and validation cohorts, the Concordance Index (C-index) of the nomogram was 0.776 and 0.818. The area under the curve (AUC) values for predicting 1-year PFS were 0.823 and 0.899, while the AUC values for predicting 2-year PFS were 0.802 and 0.810, respectively. According to the nomogram, patients were divided into three risk groups (low, medium, and high), and there were significant differences in PFS among the groups (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt;0.001). Survival analysis showed that PAT significantly improved PFS in the high-risk group (1-year: 53.3% vs. 26.7%; 2-year: 35.6% vs. 6.7%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.009), but there was no significant difference in the low and medium risk groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prognosis nomogram can effectively predict the PFS of LA-ESCC patients after NICT. Through survival risk stratification, patients in the high-risk group may benefit from PAT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1621607","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T05:31:21Z","timestamp":1753680681000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Nomogram-based risk stratification to analyze the value of receiving postoperative adjuvant therapy after neoadjuvant immunochemotherapy for patients with locally advanced esophageal squamous carcinoma"],"prefix":"10.3389","volume":"16","author":[{"given":"Qiuying","family":"An","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yage","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yibing","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiguo","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31462-9","article-title":"Oesophageal cancer","volume":"390","author":"Lagergren","year":"2017","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"393","DOI":"10.6004\/jnccn.2023.0019","article-title":"Esophageal and esophagogastric junction cancers, version 2.2023, NCCN clinical practice guidelines in oncology","volume":"21","author":"Ajani","year":"2023","journal-title":"J Natl Compr Canc Netw"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.10.508","article-title":"Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy followed by minimally invasive esophagectomy for locally advanced esophageal squamous cell carcinoma: a prospective multicenter randomized clinical trial","volume":"34","author":"Tang","year":"2023","journal-title":"Ann Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.jtcvs.2024.06.020","article-title":"Perioperative outcomes and survival after neoadjuvant immunochemotherapy for locally advanced esophageal squamous cell carcinoma","volume":"169","author":"Yang","year":"2025","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.jtcvs.2023.12.030","article-title":"Neoadjuvant chemotherapy combined with immunotherapy versus neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma","volume":"168","author":"Yu","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.39778","article-title":"Evaluation of clinical and safety outcomes of neoadjuvant immunotherapy combined with chemotherapy for patients with resectable esophageal cancer: A systematic review and meta-analysis","volume":"5","author":"Ge","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1066527","article-title":"Perioperative outcomes of neoadjuvant chemotherapy plus camrelizumab compared with chemotherapy alone and chemoradiotherapy for locally advanced esophageal squamous cell cancer","volume":"14","author":"Zhang","year":"2023","journal-title":"Front Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2024.112558","article-title":"Efficacy, safety, and survival of neoadjuvant immunotherapy plus chemotherapy in locally advanced esophageal squamous cell carcinoma: A real-world retrospective study","volume":"138","author":"Guo","year":"2024","journal-title":"Int Immunopharmacol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2024.109546","article-title":"Patterns of recurrence after esophagectomy following neoadjuvant immunochemotherapy in patients with thoracic esophageal squamous cell carcinoma","volume":"51","author":"An","year":"2024","journal-title":"Eur J Surg Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/1759-7714.15291","article-title":"Neoadjuvant chemoimmunotherapy for locally advanced esophageal squamous cell carcinoma: Data from literature review and a real-world analysis","volume":"15","author":"Zhang","year":"2024","journal-title":"Thorac Cancer"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/1759-7714.70021","article-title":"Postoperative adjuvant therapy benefits non-pCR patients rather than pCR patients for locally advanced ESCC: A multicenter real-world study","volume":"16","author":"Liu","year":"2025","journal-title":"Thorac Cancer"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1456193","article-title":"Adjuvant immunotherapy after neoadjuvant immunochemotherapy and esophagectomy for esophageal squamous cell carcinoma: a real-world study","volume":"15","author":"Feng","year":"2024","journal-title":"Front Immunol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1332492","article-title":"Adjuvant therapy provides no additional recurrence-free benefit for esophageal squamous cell carcinoma patients after neoadjuvant chemoimmunotherapy and surgery: a multi-center propensity score match study","volume":"15","author":"Xie","year":"2024","journal-title":"Front Immunol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1548520","article-title":"Survival benefits of postoperative radiotherapy in esophageal cancer during the immunotherapy era:a retrospective cohort study based on the SEER database and a single-center registry in China","volume":"16","author":"Zhang","year":"2025","journal-title":"Front Immunol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1186\/s12885-021-08747-y","article-title":"Evaluating the effect of Neoadjuvant chemotherapy for esophageal Cancer using the RECIST system with shorter-axis measurements: a retrospective multicenter study","volume":"21","author":"Taniyama","year":"2021","journal-title":"BMC Cancer"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2024.103934","article-title":"Disease-free survival as surrogate for overall survival in real-world settings for esophageal cancer: an analysis of SEER-Medicare data","volume":"9","author":"Ajani","year":"2024","journal-title":"ESMO Open"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2032125","article-title":"Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer","volume":"384","author":"Kelly","year":"2021","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.smim.2021.101480","article-title":"Emerging concepts in PD-1 checkpoint biology","volume":"52","author":"Pauken","year":"2021","journal-title":"Semin Immunol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1530279","article-title":"A preoperative predictive model based on multi-modal features to predict pathological complete response after neoadjuvant chemoimmunotherapy in esophageal cancer patients","volume":"16","author":"Qi","year":"2025","journal-title":"Front Immunol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2024-011149","article-title":"Voxel-level radiomics and deep learning for predicting pathologic complete response in esophageal squamous cell carcinoma after neoadjuvant immunotherapy and chemotherapy","volume":"13","author":"Zhang","year":"2025","journal-title":"J Immunother Cancer"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S182436","article-title":"Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer","volume":"10","author":"Wang","year":"2018","journal-title":"Cancer Manag Res"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.7555\/JBR.35.20210034","article-title":"A nomogram for predicting lymph node metastasis in superficial esophageal squamous cell carcinoma","volume":"35","author":"Zhang","year":"2021","journal-title":"J BioMed Res"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14915","article-title":"Nomogram for prediction of lymph node metastasis in patients with superficial esophageal squamous cell carcinoma","volume":"35","author":"Min","year":"2020","journal-title":"J Gastroenterol Hepatol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-022-02430-x","article-title":"Impact of CT-assessed changes in tumor size after neoadjuvant chemotherapy on pathological response and survival of patients with esophageal squamous cell carcinoma","volume":"407","author":"Matsumoto","year":"2022","journal-title":"Langenbecks Arch Surg"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-024-15314-9","article-title":"Utility of initial tumor reduction as a prognostic factor in esophageal squamous cell cancer patients undergoing neoadjuvant chemotherapy followed by surgery: A retrospective cohort study","volume":"31","author":"Hagi","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31815aaadf","article-title":"The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent","volume":"247","author":"Mariette","year":"2008","journal-title":"Ann Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1080\/15384047.2024.2417464","article-title":"S-1-based concurrent chemoradiotherapy plus nimotuzumab in patients with locally advanced esophageal squamous cell carcinoma who failed neoadjuvant therapy: a real-world prospective study","volume":"25","author":"Wang","year":"2024","journal-title":"Cancer Biol Ther"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-023-14534-9","article-title":"A comparison of clinicopathologic outcomes and patterns of lymphatic spread across neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy, and neoadjuvant immunochemotherapy in locally advanced esophageal squamous cell carcinoma","volume":"31","author":"Tian","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jncc.2023.02.002","article-title":"Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): a multicenter prospective cohort study","volume":"3","author":"Mao","year":"2023","journal-title":"J Natl Cancer Cent"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2022.11.026","article-title":"Minimally invasive surgery is associated with decreased postoperative complications after esophagectomy","volume":"166","author":"Dyas","year":"2023","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2012.589","article-title":"Risk factors for postoperative respiratory complications following esophageal cancer resection","volume":"3","author":"Shiozaki","year":"2012","journal-title":"Oncol Lett"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-024-15596-z","article-title":"Minimally invasive esophagectomy provides better short- and long-term outcomes than open esophagectomy in locally advanced esophageal cancer","volume":"31","author":"Terayama","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.7150\/jca.96574","article-title":"Impact of the number of lymph node dissections and a novel risk stratification on the prognosis in elderly locally advanced esophageal adenocarcinoma","volume":"15","author":"Wu","year":"2024","journal-title":"J Cancer"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1924","DOI":"10.1016\/j.cell.2022.04.019","article-title":"Lymph node colonization induces tumor-immune tolerance to promote distant metastasis","volume":"185","author":"Reticker-Flynn","year":"2022","journal-title":"Cell"},{"key":"B36","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1038\/s41392-023-01576-4","article-title":"Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions","volume":"8","author":"Ji","year":"2023","journal-title":"Signal Transduct Target Ther"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2019.08.008","article-title":"Tumor-draining lymph nodes demonstrate a suppressive immunophenotype in patients with non-small cell lung cancer assessed by endobronchial ultrasound-guided transbronchial needle aspiration: A pilot study","volume":"137","author":"Murthy","year":"2019","journal-title":"Lung Cancer"},{"key":"B38","doi-asserted-by":"publisher","first-page":"2113","DOI":"10.1038\/s41467-018-04524-x","article-title":"Induction of anergic or regulatory tumor-specific CD4(+) T cells in the tumor-draining lymph node","volume":"9","author":"Alonso","year":"2018","journal-title":"Nat Commun"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1158\/2159-8290.CD-11-0314","article-title":"The HIF-1\u03b1 hypoxia response in tumor-infiltrating T lymphocytes induces functional CD137 (4-1BB) for immunotherapy","volume":"2","author":"Palaz\u00f3n","year":"2012","journal-title":"Cancer Discov"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2020.06.046","article-title":"A meta-analysis on surgery with or without postoperative radiotherapy to treat squamous cell esophageal carcinoma","volume":"80","author":"Lin","year":"2020","journal-title":"Int J Surg"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1621607\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T05:31:21Z","timestamp":1753680681000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1621607\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,28]]},"references-count":40,"alternative-id":["10.3389\/fimmu.2025.1621607"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1621607","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,28]]},"article-number":"1621607"}}