{
  "abstract": "Background: While primary surgery remains a crucial treatment for resectable esophageal squamous cell carcinoma (ESCC), the uniform application of postoperative adjuvant chemotherapy for pathologically node-positive patients exposes many to severe systemic toxicity. This study hypothesizes the existence of a specific lymph node dissection (LND) threshold that stratifies the survival benefit of adjuvant chemotherapy and aims to define this cutpoint to enable safe therapeutic de-escalation.\n\nMethods: We conducted a multi-cohort retrospective study using data from the Surveillance, Epidemiology, and End Results (SEER) database (n = 753, training cohort) and a Chinese single-center repository (n = 447, validation cohort) of patients with ESCC who underwent primary radical esophagectomy without radiotherapy. The optimal prognostic cutpoint for LND was mathematically determined using X-tile software. An interactive Cox proportional hazards nomogram incorporating an LND-by-chemotherapy interaction term was developed and validated. Subsequently, layer-specific 1:1 propensity score matching (PSM) was performed within separate surgical strata of the validation cohort to assess chemotherapy efficacy.\n\nResults: X-tile analysis established 21 lymph nodes as the optimal LND threshold. Multivariable analysis confirmed that adequate LND (≥ 21 nodes) and adjuvant chemotherapy were independent protective prognostic factors. The interactive nomogram demonstrated good discrimination and calibration across both populations. Crucially, layer-specific PSM in the external validation cohort revealed divergent therapeutic responses dependent on surgical quality. For patients with suboptimal LND (< 21 nodes), adjuvant chemotherapy provided a significant survival benefit over surgery alone (P = 0.048). In contrast, for patients achieving an adequate LND (≥21 nodes), the addition of adjuvant chemotherapy yielded no further survival advantage (P = 0.085).\n\nConclusions: Achieving the removal of ≥ 21 lymph nodes serves as a robust anatomical biomarker that fundamentally alters the postoperative therapeutic landscape for ESCC. Patients with suboptimal LND require adjuvant chemotherapy to compensate for potential residual disease, whereas those achieving the 21-node clearance threshold derive no additional survival benefit from systemic interventions and can be safely exempted from cytotoxic over-treatment.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic Surgery, Fujian Medical University Union Hospital",
    "Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University)",
    "Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education",
    "Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University",
    "Clinical Research Center for Thoracic Tumors of Fujian Province, Fujian Medical University"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Yicheng Huang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xuanhao Lin"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yanhong Lin"
    },
    {
      "affs": [
        0,
        1,
        2,
        3,
        4
      ],
      "name": "Ziyang Han"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8k332m6dsevbe.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1920549",
  "fulltext_url": null,
  "id": "8k332m6dsevbe",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1920549/full",
  "language": null,
  "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": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-29",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/8k332m6dsevbe.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:14Z",
      "native_id": "10.3389/fonc.2026.1920549",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1920549/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2234-943X",
      "subfield": "oncology"
    }
  ],
  "title": "Extent of lymphadenectomy dictates adjuvant chemotherapy benefit in primarily resected esophageal squamous cell carcinoma: a multi-cohort validation",
  "title_text": "Extent of lymphadenectomy dictates adjuvant chemotherapy benefit in primarily resected esophageal squamous cell carcinoma: a multi-cohort validation",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T00:21:08Z",
  "url": "https://research.draconitic.com/paper/8k332m6dsevbe",
  "venue": "Frontiers in Oncology",
  "versions": []
}