ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1668649
Analysis of Lymph Node Recurrence Patterns and Risk Factors in Locally Advanced Esophageal Carcinoma Following Neoadjuvant Therapy
Provisionally accepted
- Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
BACKGROUND: Although neoadjuvant therapy followed by surgery is the standard treatment for resectable locally advanced esophageal carcinoma, heterogeneity exists in neoadjuvant regimens within real-world practice. This study characterizes lymph node recurrence (LNR) patterns and compares LNR risk factors across different neoadjuvant approaches to better elucidate therapeutic efficacy. METHODS: Data were collected from esophageal carcinoma (EC) patients who underwent surgery following neoadjuvant therapy between January 2018 and December 2023. Neoadjuvant included: neoadjuvant chemotherapy (NCT), neoadjuvant chemoimmunotherapy (NICT), and neoadjuvant chemoradiotherapy/chemoradiotherapy-immunotherapy (NCRT/NICRT). Regional lymph node stations were defined per the Japanese Esophageal Society (JES) criteria. Cox proportional hazards models were used to identify factors associated with LNR. RESULTS: This study enrolled 658 patients, including 195 with postoperative LNR. Among all EC cases, the most frequent recurrence sites were No.106tb (5.5%), 109 (5.5%), and 104 (8.7%). The most frequent recurrence sites in the NCT group were No.104 (10.0%) and 106tb (7.9%); in the NICT group, No.104 (8.2%) is most common; while in the NCRT/NICRT group, No.101 (7.0%) and 104 (7.0%) demonstrated the highest recurrence rates. In upper thoracic EC, No.101, 104, and 105 were common recurrence sites with metastasis rates exceeding 5%; in mid-thoracic EC, No.104 (11.9%) showed the highest recurrence frequency; in lower thoracic and gastroesophageal junction EC, No.104 (5.5%) and 16 (4.8%) were frequent recurrence locations. Lymph node dissection count and ypT and/or ypN stage correlated with recurrence risk across neoadjuvant regimens. Adjuvant radiotherapy demonstrated lower lymph node metastasis rates in the tracheoesophageal groove and upper mediastinal LNR. CONCLUSIONS: The tracheoesophageal groove and supraclavicular lymph nodes represent common recurrence sites in neoadjuvant therapy and upper thoracic EC. Lower thoracic and gastroesophageal junction EC require vigilance for supraclavicular nodal metastasis risk. Lymph node yield, and T/N stages correlate with recurrence risk.
Keywords: esophageal cancer, Neoadjuvant Therapy, adjuvant therapy, lymph nodes recurrence, Risk factors
Received: 18 Jul 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Liu, Wang, Ni, Zeng, Yutao, Zhang, Qian and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Pudong Qian, qpd201210@163.com
Yatian Liu, lyt_84@163.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.