For patients with T1-2 ESCC, the degree of lymphadenectomy during esophagectomy is still up for debate. In order to accurately stage T1-2 esophageal squamous cell carcinoma (ESCC) patients’ nodes and determine their overall survival (OS), researchers set out to determine the minimal number of examined lymph nodes (ELN).

Retrospective reviews of patients with T1-2 ESCC from three institutes between January 2011 and December 2020 were conducted. Multivariable models were used to assess the relationships between ELN count and nodal migration and OS, and locally weighted scatterplot smoothing (LOWESS) was used to show the results. The structural breakpoints of the ELN count were identified using the Chow test. There was external validation in the SEER database.

There were 1,537 patients covered in all. A higher risk of having positive nodal illness and incremental OS was linked to increasing ELNs. With validation in the SEER database (n=519), the minimal number of ELNs for precise nodal staging and optimum survival were 14 and 18, respectively. In the group with more or around 14 ELNs compared to those with fewer ELNs (iAUC, 0.70 (95% CI 0.66-0.74), the prognostic prediction ability of N stage was better versus 0.61(95%CI 0.57–0.65)). Those with more or equal to 18 ELNs had a better prognosis than patients with less than 18 ELNs (iAUC, 0.78 (95% CI 0.74-0.82) versus 0.73 (95% CI 0.7-0.77)).

For stage T1-2 ESCC patients to have an optimum chance of survival, there needed to be at least 14 and 18, respectively, ELNs.