Abstract Background Currently, neoadjuvant chemoimmunotherapy (nCIT) is widely used in the perioperative treatment of esophageal squamous cell carcinoma (ESCC).In addition, nodal metastases decreased in frequency and changed in distribution after neoadjuvant therapy.This study aimed to examine the optimal strategy for lymph node dissection in patients with ESCC who underwent nCIT. Methods We retrospectively analyzed cases from Feb 2020 to Sept 2023 in three hospitals and selected patients who underwent NCIT followed by R0 resection for ESCC.The hazard ratios (HRs) for disease-free survival (DFS) was calculated using the Cox proportional hazard model. The minimal number of lymph node(m-NLN) or least station of lymph node(l-SLN) were used to obtain the optimal breakpoint for predicting the endpoint event by the maxstat function in R. Results In total, 149 patients were included.The estimated cut-off values for l-SLN and m-NLN were 8 and 20, respectively.The m-NLN 20 was significantly associated with better DFS prognosis (HR = 0.29, 95% CI: 0.14, 0.60, p 0.001), and l-SLN 8 was also significantly associated with DFS prognosis (HR = 0.40, 95% CI: 0.20, 0.84, p = 0.015).The m-NLN was a significant prognostic factor in multivariate analyses.A subgroup analysis was conducted on m-NLN in patients undergoing postoperative immune maintenance.The m-NLN 20 and 40 was significantly associated with better DFS prognosis (HR = 0.29, 95% CI: 0.14, 0.60, p 0.001). Conclusion This cohort study revealed an association between the extent of LND and overall survival, suggesting the therapeutic value of extended lymphadenectomy during esophagectomy.A higher number of lymph node stations and lymph nodes sampled is associated with improved prognosis in patients undergoing nCIT. It is recommended to perform standard lymph node dissection involving at least 9 lymph node stations and 21 lymph nodes.Standard lymph node dissection involving 21 to 39 lymph nodes results in better outcomes for patients receiving postoperative immunotherapy.
Hu et al. (Fri,) studied this question.