{
  "abstract": "Background: Neoadjuvant chemoimmunotherapy (nCIT) has emerged as a standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the independent prognostic value of postoperative pathological N stage (ypN) and to assess whether pre-treatment clinical N stage (cN) provides additional prognostic information in patients achieving ypN0.\n\nMethods: We retrospectively analyzed 194 ESCC patients who received nCIT followed by radical esophagectomy between January 2019 and December 2024. Patients were stratified into three groups: cN0/ypN0 (n=104), cN+/ypN0 (n=32), and ypN+ (n=58). Kaplan-Meier analysis and Cox proportional hazards models were used for survival analysis. Multivariable models were constructed using a clinically informed variable-selection strategy constrained by the number of events. For the three pairwise comparisons, unadjusted P values were compared against a Bonferroni-adjusted significance threshold of alpha=0.017 (0.05/3).\n\nResults: A total of 194 patients were enrolled, with 31 deaths and 37 recurrences during a median follow-up of 34.0 months (reverse Kaplan–Meier). ypN+ patients had significantly worse overall survival (OS) and recurrence-free survival (RFS) than ypN- patients (both Log-rank P<0.001). In the primary multivariable model, ypN+ was an independent adverse prognostic factor for OS (HR = 3.204, 95%CI: 1.563-6.568, P = 0.001) and RFS (HR = 3.780, 95%CI: 1.943-7.356, P<0.001), and remained robust across extended, cycle-adjusted, and landmark sensitivity analyses. Among the three groups, ypN+ showed significantly shorter OS compared with both ypN0 groups (P = 0.002 vs cN0/ypN0; P = 0.008 vs cN+/ypN0; both below the Bonferroni threshold) and shorter RFS compared with cN0/ypN0 (P<0.001). No significant difference was observed between cN0/ypN0 and cN+/ypN0 groups for OS (P = 0.259); the RFS comparison was nominally significant but did not survive Bonferroni correction (HR = 2.799, 95%CI: 1.048-7.479, unadjusted P = 0.040).\n\nConclusion: Postoperative ypN stage is the core prognostic determinant in ESCC after nCIT. In patients achieving ypN0, pre-treatment cN did not demonstrate statistically significant additional prognostic discrimination in this cohort, although estimates were imprecise due to the small cN+/ypN0 subgroup and limited events. Postoperative risk assessment should be based primarily on ypN status; these findings require validation in larger, preferably multicenter, cohorts.",
  "abstract_shown": true,
  "affiliations": [
    "Medical School of Chinese PLA",
    "Department of Thoracic Surgery, The First Medical Centre, Chinese PLA General Hospital",
    "School of Medicine, Nankai University"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Herui Han"
    },
    {
      "affs": [
        1
      ],
      "name": "Xiaobin Hou"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yiming Liu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Wenhan Cai"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Jiamei Jin"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiangming Qiu"
    },
    {
      "affs": [
        0
      ],
      "name": "Zirui Zhu"
    },
    {
      "affs": [
        0
      ],
      "name": "Kai Zhao"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Mingchuan Hu"
    },
    {
      "affs": [
        1
      ],
      "name": "Zhiqiang Xue"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3tkk81rfdpsp9.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1931817",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1931817/full",
  "id": "3tkk81rfdpsp9",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1931817/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC254-282"
    ],
    [
      "openalex",
      "2746|Esophageal Cancer Research and Treatment"
    ]
  ],
  "openalex": "W7223397619",
  "pdf_url": "https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1931817/pdf",
  "pmcid": "PMC13739558",
  "pmid": "42996502",
  "published": "2026-10-23",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/3tkk81rfdpsp9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:13Z",
      "native_id": "10.3389/fonc.2026.1931817",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1931817/full"
    },
    {
      "first_seen": "2026-10-30T13:43:13Z",
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      "url": "https://doi.org/10.3389/fonc.2026.1931817"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Esophageal Cancer Research and Treatment",
      "subfield": "surgery"
    }
  ],
  "title": "Prognostic significance of lymph node staging in esophageal squamous cell carcinoma after neoadjuvant chemoimmunotherapy",
  "title_text": "Prognostic significance of lymph node staging in esophageal squamous cell carcinoma after neoadjuvant chemoimmunotherapy",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/3tkk81rfdpsp9",
  "venue": "Frontiers in Oncology",
  "versions": []
}