LAUSR

Background: Approximately 25% of patients with esophageal adenocarcinoma achieve pathological complete response (pathCR) after chemoradiotherapy with following surgery (trimodality therapy). The prediction for pathCR would provide an important guidance for decision making regarding surgical strategy. Previous studies have used the logistic regression model to predict pathCR, however, few studies utilized the machine learning models. In this study, we aimed to establish a predictive model for pathCR using the machine learning models using clinical data in patients with GEJ cancer treated by trimodality therapy. Methods: 512 patients with localized esophageal and GEJ adenocarcinoma who received trimodality therapy in MD Anderson Cancer Center between 2002 to 2020 were included. We first performed survival analysis to confirm the survival benefit of pathCR. Then, several prediction models commonly used in machine learning, including logistic regression, LASSO, Random Forest, BART, and xgboost were used to predict pathCR. Each method was trained and validated using 10-fold cross-validation. Results: A total of 125 patients (24 %) achieved a path CR. Patients who achieved path CR had significantly longer overall survival (OS) and relapse free survival (RFS) than