ArticleAnnals of surgical oncology2026
Prognostic Impact of Bulky Lymph Node Metastasis in Thoracic Esophageal Squamous Cell Carcinoma: A Multicenter Cohort Study.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- ASO Author Reflections: Bulky Lymph Node Metastasis in ESCC: Beyond Nodal Size Toward Response-Defined Risk.Annals of surgical oncology · 2026Article
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Authors and funding
11 authors.
Funding
Abstract
backgroundThe prognostic relevance of bulky lymph node metastases in esophageal squamous cell carcinoma (ESCC) after neoadjuvant immunochemotherapy remains uncertain.
methodsThis multicenter retrospective cohort included 1247 patients with thoracic ESCC receiving PD-1 inhibitor-based immunochemotherapy followed by R0 esophagectomy at three Chinese centers during 2020-2025. Bulky nodal disease was defined as a radiologically suspected metastatic lymph node with maximum axial diameter ≥ 20 mm. Pathologic response, nodal downstaging, recurrence, postoperative morbidity, overall survival (OS), and disease-free survival (DFS) were compared. Cox models evaluated prognostic association and incremental value beyond cTNM staging.
resultsBulky nodal disease occurred in 218 patients (17.5%) and was associated with more advanced cT, cN, and cM categories. Pathologic complete response (pCR) (19.3% vs. 21.1%; P = .55) and major pathologic response (48.2% vs. 43.5%; P = .21) rates were comparable. Among cN-positive patients, nodal downstaging was less frequent with bulky disease (40.8% vs. 57.1%; P < .001), with more residual positive lymph nodes (2.5 vs. 1.1; P < .001). Two-year OS was 71.9% versus 77.6% (P = .03), and DFS was 64.3% vs. 73.4% (P = .003). Distant recurrence was more frequent (9.6% vs. 4.7%; P = .004). After additional adjustment for cT, cN, and cM, bulky status was no longer significantly associated with DFS or OS and did not improve model fit. Among patients achieving pCR, survival and recurrence did not differ by bulky status.
conclusionsBulky nodal disease marks an imaging-defined high-risk ESCC phenotype characterized by poorer nodal response and observed survival, but its incremental prognostic value beyond cTNM staging appears limited. Pathologic complete response attenuated its adverse prognostic association.
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Registered trials
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