Pan-endoscopic tumor length as the marker to predict response to neoadjuvant therapy for ESCC warrants additional investigation

We read the report by Lin and colleagues on the predictive value of tumor length for patients with resectable esophageal squamous cell carcinoma with great interest (1). A survival benefit among patients with esophageal cancer receiving neoadjuvant chemoradiotherapy has been consistently reported (2). However, the lack of predictive markers associated with neoadjuvant concurrent chemoradiotherapy (nCCRT) sensitivity represents a major challenge for the development of nCCRT, which has attracted significant interest in recent years (3). Lin and colleagues should be commended for their efforts in establishing criteria based on initial pan-endoscopic tumor length to select appropriate esophageal squamous cell carcinoma (ESCC) patients for nCCRT followed by esophagectomy. Upper gastrointestinal (GI) endoscopy is routinely performed in every patient with ESCC. Therefore, this predictive model for nCCRT efficacy is readily available and highly practical. However, some points of the manuscript warrant discussion