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Clinical Studies

Combined regression score predicts outcome after neoadjuvant treatment of oesophageal cancer



Histopathologic regression following neoadjuvant treatment (NT) of oesophageal cancer is a prognostic factor of survival, but the nodal status is not considered. Here, a score combining both to improve prediction of survival after neoadjuvant therapy is developed.


Seven hundred and fifteen patients with oesophageal squamous cell (SCC) or adenocarcinoma (AC) undergoing NT and esophagectomy were analysed. Histopathologic response was classified according to percentage of vital residual tumour cells (VRTC): complete response (CR) without VRTC, major response with <10% VRTC, minor response with >10% VRTC. Nodal stage was classified as ypN0 and ypN+. Kaplan–Meier and Cox regression were used for survival analysis.


Survival analysis identified three groups with significantly different mortality risks: (1) low-risk group for CR (ypT0N0) with 72% 5-year overall survival (5y-OS), (2) intermediate-risk group for minor/major responders and ypN0 with 59% 5y-OS, and (3) high-risk group for minor/major responders and ypN+ with 20% 5y-OS (p < 0.001). Median survival in AC and SCC cohorts were comparable (3.8 (CI 95%: 3.1, 5.3) vs. 4.6 years (CI 95%: 3.3, not reached), p = 0.3).


Histopathologic regression and nodal status should be combined for estimating AC and SCC prognosis. Poor survival in the high-risk group highlights need for adjuvant therapy.

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Fig. 1: Flow chart of patient selection.
Fig. 2: Overall survival of AC patients after CROSS and FLOT and SCC patients after CROSS.
Fig. 3: Overall survival stratified by nodal status in AC and SCC after CROSS or FLOT neoadjuvant therapy.
Fig. 4: Overall survival stratified by UICC and complete response in the AC and SCC cohort after CROSS and FLOT.
Fig. 5: Overall survival stratified by local tumour response and nodal status into four groups.
Fig. 6: Overall survival according to proposed risk score.

Data availability

Data are available on request to the corresponding author due to privacy/ethical restrictions.


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Authors and Affiliations



AID: conceptualisation, methodology, formal analysis, investigation, writing—original draft, visualisation, data curation, revisions, point-by-point response. FG: conceptualisation, investigation, resources, data curation, writing—review and editing, validation. AS: investigation, data curation, methodology. HS: conceptualisation, writing—review and editing. MG: investigation, data curation. HF: resources, data curation, writing—review and editing. TZ: investigation, conceptualisation, writing—review and editing. TS: writing—review and editing. LS: writing—review and editing. AQ: conceptualisation, data curation, methodology, writing—original draft, supervision, validation. CB: resources, supervision, writing—review and editing, revisions. WS: project administration, supervision, data curation, investigation, methodology, writing—original draft, validation, revisions, point-by-point response.

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Correspondence to W. Schroeder.

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Damanakis, A.I., Gebauer, F., Stapper, A. et al. Combined regression score predicts outcome after neoadjuvant treatment of oesophageal cancer. Br J Cancer 128, 2025–2035 (2023).

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