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Refining post-neoadjuvant risk stratification in ESCC with lymph node regression grade.

Wenxin Liang^1,2,3, Maohui Chen^1,2,3, Deyong Kang⁴

¹Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.

Frontiers in Oncology

|June 1, 2026

Summary

This summary is machine-generated.

Lymph node regression grade (LRG) is a valuable prognostic indicator for esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemotherapy (NAC). Improved risk stratification using LRG can guide personalized treatment strategies.

Keywords:

esophageal squamous cell carcinoma neoadjuvant chemotherapy risk stratification tumor prognosis tumor regression grade

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Area of Science:

Oncology
Gastroenterology
Pathology

Background:

Locally advanced esophageal squamous cell carcinoma (ESCC) treatment typically involves neoadjuvant chemotherapy (NAC) followed by surgery.
Reliable prognostic indicators after NAC for ESCC are limited.
Lymph node regression grade (LRG) is a potential prognostic marker.

Purpose of the Study:

To evaluate the prognostic value of LRG in ESCC patients who received NAC.
To determine if LRG provides prognostic information independent of primary tumor response.
To develop nomograms for improved risk stratification and individualized management.

Main Methods:

Retrospective review of 173 ESCC patients treated with NAC and surgery.
Categorization of patients based on LRG: lymph-node response (LN-R), lymph-node non-response (LN-NR), and lymph-node negative (LN-Neg).
Kaplan-Meier and multivariable Cox regression analyses to assess overall survival (OS) and disease-free survival (DFS).

Main Results:

Five-year OS rates were significantly different across LRG groups (69.2% for LN-R, 57.4% for LN-Neg, 24.6% for LN-NR).
LRG was independently associated with reduced risks of death and recurrence (HR=0.38 for LN-R).
Poor differentiation and advanced ypT stage were identified as adverse prognostic factors.

Conclusions:

LRG offers independent prognostic information in ESCC post-NAC.
Integrating LRG into risk stratification can enhance prognostic assessment.
LRG aids in guiding individualized treatment strategies in the era of precision medicine.