A real-world study of 178 esophageal cancer patients found that residual tumor burden after immunotherapy predicted survival and recurrence patterns. Residual tumor grade and post-treatment lymph node status—particularly ypN3—were highlighted as strong prognostic indicators. Unlike a purely trial-based biomarker readout, the dataset emphasizes how real-world post-therapy pathology can stratify risk after neoadjuvant immunochemotherapy. That could influence follow-up intensity, trial enrichment, and adjuvant decision pathways. For investigators, the key is that residual disease features remained informative enough to separate outcomes even outside highly controlled trial environments.