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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Surgical Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1430876

Prognostic significance of lymph node ratio in esophageal squamous cell carcinoma: Insights from the South Asian population

Provisionally accepted
Sajida Qureshi Sajida Qureshi 1*Waqas Ahmad Abbasi Waqas Ahmad Abbasi 1Hira Abdul Jalil Hira Abdul Jalil 1Saba Mughal Saba Mughal 2Muhammad Saeed Quraishy Muhammad Saeed Quraishy 1
  • 1 Dow Medical College, Dow University of Health Sciences, Karachi, Punjab, Pakistan
  • 2 School of Public Health, Dow University of Health Sciences, Karachi, Punjab, Pakistan

The final, formatted version of the article will be published soon.

    Background: Esophageal cancer (EC) is a significant health concern in South Asia, yet data on prognostic factors, such as lymph node ratio (LNR), in this region is limited. This study aims to assess the prognostic significance of LNR in esophageal squamous cell carcinoma (ESCC) patients undergoing concurrent neoadjuvant therapy followed by minimally invasive esophagectomy (MIE). Methods: This retrospective study analyzed the clinical data of ESCC patients who underwent concurrent neoadjuvant therapy followed by MIE at Dr. Ruth K. M. Pfau Civil Hospital from 2019 to 2023. Lymph node ratios were derived and patients were categorized into three groups: LNR 0, LNR low (≤ 0.1), and LNR high (>0.1). Patient characteristics compared along with lymph node groups, lymph nodes positivity, and survival outcomes were analyzed using the Kruskal Wallis and Chi-square/ Fisher exact test, Pearson correlation, Kaplan-Meier (KM) estimates, and Cox regression models. Results: Among the 47 patients, 15 (31.9%) deaths were observed. Patients with a high LNR had a higher mortality rate (70%) compared to those with a low LNR (41.7%) and 0 LNR (12%) (p = 0.002). Additionally, patients with a high LNR (>0.1) were associated with poorer overall survival (OS) (30.0% vs. 58.3% vs. 88.0%, p < 0.001). A significant correlation was also observed between LNR and the number of metastatic lymph nodes (correlation coefficient = 0.928, p < 0.001). Conclusion: Our findings demonstrate that LNR emerged as an independent prognostic factor in ESCC patients undergoing concurrent neoadjuvant therapy followed by MIE. Furthermore, higher LNR values were indicative of poorer OS.

    Keywords: Esophageal carcinoma, lymph node ratio, prognosis, surgical resection, Minimally invasive esophagectomy

    Received: 10 May 2024; Accepted: 23 Dec 2024.

    Copyright: © 2024 Qureshi, Abbasi, Jalil, Mughal and Quraishy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Sajida Qureshi, Dow Medical College, Dow University of Health Sciences, Karachi, Punjab, Pakistan

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.