Prognostic Impact of Lymph Node Ratio on Survival Outcomes in Esophageal Squamous Cell Carcinoma: A Predictive Analysis

Background Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer-related mortality, with survival outcomes heavily influenced by lymph node (LN) involvement. The TNM staging system introduced a refined nodal classification but does not define the optimal number of examined LN ratio, risking stage migration. The lymph node ratio (LNR), calculated as metastatic LNs/total resected LNs, has been proposed as a better prognostic marker than absolute node count. This study examined the prognostic impact of LNR in ESCC, comparing it with TNM staging, to improve risk stratification and guide treatment strategies for better patient outcomes. Methods This study examined the prognostic impact of lymph node ratio (LNR) on survival outcomes in esophageal squamous cell carcinoma (ESCC). Data from electronic medical records included demographics, tumor characteristics, lymph node status, and survival outcomes. Patients were categorized based on LNR cutoffs (<0.2, 0.2–0.4, >0.4). Survival analysis was conducted using the Kaplan–Meier method, with log-rank tests for comparisons. Cox proportional hazards regression identified LNR’s independent prognostic significance. SPSS software was used, with p < 0.05 considered statistically significant. Results This study analyzed 250 ESCC patients, stratified by lymph node ratio (LNR) categories to assess survival impact. Higher LNR (>0.4) correlated with poorer outcomes, with overall survival of 15.3 vs. 28.5 months in LNR <0.2 (p < 0.001). Patients in LNR 0.2–0.4 had 46% lower odds of survival, while LNR >0.4 had 67% lower survival odds compared to LNR <0.2 (p < 0.001). Most patients were male (70%), smokers (60%), and had T3 tumors (50%) with nodal metastasis (70%). R0 resection was achieved in 95%, but 40% had lymphovascular invasion and 35% had perineural invasion. Conclusion This study confirms lymph node ratio (LNR) as an independent prognostic factor in esophageal squamous cell carcinoma (ESCC). Higher LNR (>0.4) significantly reduced survival, making it a more reliable predictor than TNM staging. Patients with advanced disease (T3 tumors, nodal metastasis in 70%) had poorer outcomes, especially with lymphovascular (40%) and perineural invasion (35%). R0 resection was achieved in 95%, but higher LNR correlated with lower survival odds. These findings suggest that LNR should be integrated into ESCC staging models to improve risk stratification and treatment decisions, with further research needed for validation.