Recurrence patterns and prognosis of esophageal cancer patients based on the Rbr resection status.

Introduction: Despite achieving complete resection (R0) and pathological complete response (pCR) in esophageal squamous cell carcinoma (ESCC) patients, recurrence is still observed, resulting in poorer overall survival (OS). We introduced a resection status classification, Rbr+/-, which complements the R0 classification. Materials and methods: We retrospectively reviewed ESCC patients who underwent neoadjuvant therapy plus curative surgery in the Department of Thoracic Surgery at the First Affiliated Hospital of Zhengzhou University between April 2017 and August 2023. Overlap weighting (OW) was used to balance the baseline characteristics between Rbr+ and Rbr-. Logistic and Cox regression models were conducted to evaluate the association of Rbr status with locoregional recurrence (LRR) and LRR-free survival (LRRFS) and overall survival (OS). Results: In total, 443 eligible patients were included and categorized into Rbr+ (141 patients) and Rbr- (302 patients) groups. After OW, LRR remained significantly higher in the Rbr+ group (20.1% vs 11.4%, p =0.034, SMD = 0.242). Multivariable logistic regression revealed that Rbr+ was associated with the higher risk of LRR (p=0.018, OR: 2.19, 95% CI: 1.14-4.17). The Kaplan-Meier (K-M) curve revealed a worse LRRFS (log-rank p=0.018) in the Rbr+ group. According to the multivariable Cox regression analysis, Rbr+ was significantly associated with poor LRRFS (p = 0.016, HR: 2.15, 95% CI: 1.15-4.01) but not OS (p = 0.120, HR: 1.52, 95% CI: 0.90-2.58). Conclusions: Rbr+ is associated with a higher LRR rate and poorer LRFS but not OS. A prospective study is necessary to further validate these findings.