Radial tumor thickness by endoscopic ultrasonography as a predictor of pathological complete response in esophageal squamous cell carcinoma

² State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China

³ Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China

⁴ Department of Endoscopy, Endoscope Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China

⁵ Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China

CP, 026110015 https://doi.org/10.36922/CP026110015

Received: 15 March 2026 | Revised: 3 April 2026 | Accepted: 8 April 2026 | Published online: 19 May 2026

© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

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Abstract

Pathological complete response (pCR) after neoadjuvant therapy is associated with improved prognosis, and reliable tools are needed to evaluate treatment response before surgery. Endoscopic ultrasonography (EUS) has been suggested as a more effective modality than computed tomography and white light endoscopy (WLE). A total of 139 patients with esophageal cancer—who received neoadjuvant therapy followed by surgery at Sun Yat-sen University Cancer Center, Guangzhou, China, between December 2006 and April 2022—were enrolled in this study. Each patient underwent EUS prior to surgery. EUS, WLE, and computed tomography scans were evaluated for features associated with pCR based on postoperative pathology. Of the 139 patients, 28 with severe esophageal stricture, three unable to tolerate examination, and two with adenocarcinoma were excluded. In the remaining 106 patients, univariate analysis showed that lesion length, maximal radial tumor thickness, T stage, and N stage (assessed by EUS), tumor macroscopic findings (WLE), biopsy results, tumor regression grade, and pathological T stage differed significantly. Furthermore, predictive performance analysis showed that EUS infiltration depth had the highest accuracy for predicting pCR, with an area under the curve of 0.79. A random forest model identified EUS infiltration depth as a key predictor. In conclusion, EUS infiltration depth after neoadjuvant therapy may predict pCR in patients with esophageal squamous cell carcinoma.

Keywords

Endoscopic ultrasonography

Neoadjuvant therapy

Pathological complete response

Esophageal squamous cell carcinoma

Infiltration depth

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

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