Predictive value of lymph node ratio on survival outcomes in esophageal squamous cell carcinoma: A tertiary cancer centre experience.

INTRODUCTION: Squamous cell carcinoma (SCC) is the most common type of esophageal cancer in the developing world. The nodal staging for it is based on the number of positive nodes at present. Lymph node ratio (LN ratio) has recently been recognized as an independent predictor of survival in esophageal cancer. We wanted to evaluate the impact of LN ratio of survival in patients undergoing esophagectomy at our center.

METHODS: A total of 164 patients undergoing esophagectomy for SCC between 2015 and 2022 at a tertiary care center were included in this study. LN ratio was defined as the number of positive nodes divided by total nodes harvested. The effect of LN ratio on survival was analyzed using Youden's index to determine cutoff and Spearman's test for correlation.

RESULTS: The mean age was 53.8 years. Mckeown's esophagectomy was done in 70.7% patients, and 34.7% were node positive. Mean lymph node harvest was 15.07. The median recurrence-free survival (RFS) was 5.63 months, and the overall survival (OS) was 12.23 months. Higher LN ratio was associated with worse RFS on univariate analysis (P < 0.001). A significant inverse correlation of LN ratio with RFS (P = 0.005) and OS (P = 0.020) was seen. ROC analysis showed a cutoff of 0.3 to predict worse survival.

CONCLUSION: The LN ratio correlates well with OS and RFS and is prognostic for esophageal SCC. Larger studies are needed to determine an exact cutoff value for nodal staging to use it effectively as a predictor of survival.