Lymph Node Regression Improves Prognostic Stratification in Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Cohort Study.
8 affiliations
- 1Department of Radiation Oncology Tianjin Medical University Cancer Institute & Hospital National Clinical Research Center for Cancer State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine Key Laboratory of Cancer Prevention and Therapy Tianjin's Clinical Research Center for Cancer Tianjin China.
- 2Department of Radiotherapy The Fourth Hospital of Hebei Medical University Shijiazhuang China.
- 3Department of Radiotherapy Shanxi Province Cancer Hospital Shanxi Hospital Affiliated to Cancer Hospital Chinese Academy of Medical Sciences Cancer Hospital Affiliated to Shanxi Medical University Taiyuan China.
- 4Department of Pathology Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital Chinese Academy of Medical Sciences Cancer Hospital Affiliated to Shanxi Medical University Taiyuan China.
- 5Department of Esophageal Surgery Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center of Cancer Key Laboratory of Cancer Prevention and Therapy of Tianjin Tianjin's Clinical Research Center for Cancer Hexi Tianjin China.
- 6Department of Minimally Invasive Esophageal Surgery Tianjin Medical University Cancer Hospital and Institute National Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy Tianjin China.
- 7Department of Pathology Tianjin Medical University Cancer Institute & Hospital National Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy Tianjin's Clinical Research Center for Cancer Tianjin China.
- 8Department of Immunology Tianjin Medical University Cancer Institute & Hospital National Clinical Research Center for Cancer State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine Key Laboratory of Cancer Immunology and Biotherapy Tianjin's Clinical Research Center for Cancer Tianjin China.
Abstract
Lymph nodes (LNs), principal sites of antitumor immunity, may undergo immune-mediated regression; whether neoadjuvant chemoimmunotherapy (NCIT)-induced regression indicates prognosis in esophageal squamous cell carcinoma (ESCC) remains unclear. We aimed to establish and validate a lymph node regression grade (LNRG) system for prognostic stratification. This multicenter, retrospective cohort study analyzed 965 patients receiving PD-1-based NCIT and surgery at three Chinese tertiary cancer centers. LNRG was the ratio of summed viable tumor area to summed bed area (residual viable plus regressed preexisting tumor) across all dissected LNs. Negative LNs were assigned LNRG 0. Survival and predictive performance were assessed using Kaplan-Meier/Cox regression, time-dependent area under the curve, Brier score, net reclassification improvement, and integrated discrimination improvement. Overall, 28,882 LNs were evaluated; patients were classified as LNRG 0-4 in 385 (39.9%), 150 (15.5%), 26 (2.7%), 141 (14.6%), and 263 (27.3%), respectively. LNRG independently predicted disease-free and overall survival, with Grades 1-2 conferring the most favorable outcomes and Grade 4 the poorest. A random survival forest model incorporating LNRG, tumor regression grade, ypAJCC stage, and perineural invasion predicted 2-year disease-free survival in training and external validation cohorts. LNRG is a novel, independent prognostic indicator after NCIT.
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BibTeX
@article{zheng2026lymph,
title = {{Lymph Node Regression Improves Prognostic Stratification in Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Cohort Study.}},
author = {Jian Zheng and Wenbin Shen and Jianzhong Cao and Linrui Gao and Likun Zan and Tian Zhang and Lei Gong and Xiaofeng Duan and Xiaobin Wang and Yueqin Wu and Peng Tang and Hongjing Jiang and Qingsong Pang and Gang Zhao and Wencheng Zhang and Cihui Yan},
journal = {MedComm},
year = {2026},
month = oct,
doi = {10.1002/mco2.71075},
url = {https://europepmc.org/article/MED/42910074},
note = {CC BY},
}
RIS
TY - JOUR
TI - Lymph Node Regression Improves Prognostic Stratification in Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Cohort Study.
AU - Jian Zheng
AU - Wenbin Shen
AU - Jianzhong Cao
AU - Linrui Gao
AU - Likun Zan
AU - Tian Zhang
AU - Lei Gong
AU - Xiaofeng Duan
AU - Xiaobin Wang
AU - Yueqin Wu
AU - Peng Tang
AU - Hongjing Jiang
AU - Qingsong Pang
AU - Gang Zhao
AU - Wencheng Zhang
AU - Cihui Yan
PY - 2026
DA - 2026/10/21
JO - MedComm
DO - 10.1002/mco2.71075
UR - https://europepmc.org/article/MED/42910074
AB - Lymph nodes (LNs), principal sites of antitumor immunity, may undergo immune-mediated regression; whether neoadjuvant chemoimmunotherapy (NCIT)-induced regression indicates prognosis in esophageal squamous cell carcinoma (ESCC) remains unclear. We aimed to establish and validate a lymph node regression grade (LNRG) system for prognostic stratification. This multicenter, retrospective cohort study analyzed 965 patients receiving PD-1-based NCIT and surgery at three Chinese tertiary cancer centers. LNRG was the ratio of summed viable tumor area to summed bed area (residual viable plus regressed preexisting tumor) across all dissected LNs. Negative LNs were assigned LNRG 0. Survival and predictive performance were assessed using Kaplan-Meier/Cox regression, time-dependent area under the curve, Brier score, net reclassification improvement, and integrated discrimination improvement. Overall, 28,882 LNs were evaluated; patients were classified as LNRG 0-4 in 385 (39.9%), 150 (15.5%), 26 (2.7%), 141 (14.6%), and 263 (27.3%), respectively. LNRG independently predicted disease-free and overall survival, with Grades 1-2 conferring the most favorable outcomes and Grade 4 the poorest. A random survival forest model incorporating LNRG, tumor regression grade, ypAJCC stage, and perineural invasion predicted 2-year disease-free survival in training and external validation cohorts. LNRG is a novel, independent prognostic indicator after NCIT.
SN - 2688-2663
ER -