Refining post-neoadjuvant risk stratification in ESCC with lymph node regression grade
Wenxin Liang1,2,3, Maohui Chen1,2,3, Deyong Kang4
1Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Background:
Neoadjuvant chemotherapy (NAC) followed by surgery is standard care for locally advanced esophageal squamous cell carcinoma (ESCC), yet reliable post-NAC prognostic indicators remain limited. We evaluated the prognostic value of lymph node regression grade (LRG) in ESCC after NAC.
Methods:
We retrospectively reviewed 173 patients with ESCC who received NAC followed by resection at Fujian Medical University Union Hospital (2013-2018). Based on LRG, patients were categorized as lymph-node response (LN-R), lymph-node non-response (LN-NR), or lymph-node negative (LN-Neg). Kaplan-Meier analyses compared overall survival (OS) and disease-free survival (DFS) among groups. Variables with P<0.05 in univariable Cox models, together with clinically relevant covariates, entered multivariable Cox regression. Nomograms for OS and DFS were developed from multivariable results; calibration curves were used to assess agreement between predicted and observed outcomes.
Results:
Five-year OS differed significantly across groups: 69.2% (LN-R), 57.4% (LN-Neg), and 24.6% (LN-NR) (P<0.001). DFS also varied significantly among the three groups (P<0.001). On multivariable analysis, LN-R status was independently associated with lower risks of death (hazard ratio=0.38) and recurrence, supporting LRG as a favorable prognostic factor. Poor differentiation (G2-G3) and advanced ypT stage (3-4) were adverse prognosticators. Nomograms incorporating LRG and pathological factors were constructed and calibrated.
Conclusions:
LRG provides independent prognostic information in ESCC after NAC, beyond primary-tumor response. Incorporating LRG into post-NAC risk stratification may refine prognostic assessment and help guide individualized management in the precision-medicine era.
