Additional benefit of standardized computed tomography-based lymph node assessment utilizing Node-RADS in esophageal adenocarcinoma

Background: Accurate lymph node staging is crucial for treatment stratification in esophageal adenocarcinoma. While endoscopic ultrasound (EUS) is standard for locoregional staging, computed tomography (CT) remains essential for detecting distant metastasis. This study aims to evaluate the Node Reporting and Data System (Node-RADS) framework, developed to standardize CT-based lymph node evaluation, in locally advanced esophageal adenocarcinomas. Materials and methods: We retrospectively included patients with histologically confirmed esophageal adenocarcinoma who were treated with multimodal therapy and curative-intent surgery between 2017 and 2023. Preoperative CT scans were scored according to Node-RADS by two independent radiologists. Kaplan-Meier and log-rank tests assessed survival differences, and multivariable Cox regression was employed to identify independent prognostic factors. Results: < 0.001). Discordant cases between EUS and Node-RADS showed intermediate survival. In multivariable analysis, only nN status and nodal status by EUS independently predicted survival. Conclusions: Node-RADS provides a reproducible CT-based method for lymph node assessment in esophageal adenocarcinoma. It positively correlates with EUS and pathological nodal involvement and independently predicts survival. Node-RADS may complement EUS for staging, but prospective studies are needed to define optimal cut-offs and validate its clinical utility.