{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T03:13:03Z","timestamp":1783739583455,"version":"3.55.0"},"reference-count":39,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","ejso.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,2]]},"DOI":"10.1016\/j.ejso.2025.111362","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T07:45:00Z","timestamp":1765871100000},"page":"111362","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["SRRN: A regional lymph node ratio\u2013based staging system enhancing prognostic accuracy in esophageal squamous cell carcinoma"],"prefix":"10.1016","volume":"52","author":[{"given":"Yanhong","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peipei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingqiang","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyang","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"3","key":"10.1016\/j.ejso.2025.111362_bib1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"9","key":"10.1016\/j.ejso.2025.111362_bib2","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1136\/gutjnl-2020-321600","article-title":"Global burden of oesophageal and gastric cancer by histology and subsite in 2018","volume":"69","author":"Arnold","year":"2020","journal-title":"Gut"},{"issue":"33","key":"10.1016\/j.ejso.2025.111362_bib3","first-page":"2552","article-title":"Chinese association of thoracic surgeons, Chinese society for thoracic and cardiovascular surgery, Chinese society for diseases of the esophagus","volume":"103","year":"2023","journal-title":"Zhonghua Yixue Zazhi"},{"key":"10.1016\/j.ejso.2025.111362_bib4","doi-asserted-by":"crossref","first-page":"106764","DOI":"10.1016\/j.ijsu.2022.106764","article-title":"The minimum number of examined lymph nodes for accurate nodal staging and optimal survival of stage T1-2 esophageal squamous cell carcinoma: a retrospective multicenter cohort with SEER database validation","volume":"104","author":"Tian","year":"2022","journal-title":"Int J Surg"},{"key":"10.1016\/j.ejso.2025.111362_bib5","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-074962","article-title":"Advances in diagnosis and management of cancer of the esophagus","volume":"385","author":"Deboever","year":"2024","journal-title":"Br Med J"},{"issue":"4","key":"10.1016\/j.ejso.2025.111362_bib6","doi-asserted-by":"crossref","first-page":"393","DOI":"10.6004\/jnccn.2023.0019","article-title":"Esophageal and esophagogastric junction cancers, version 2.2023, NCCN clinical practice guidelines in oncology","volume":"21","author":"Ajani","year":"2023","journal-title":"J Natl Compr Cancer Netw"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib7","first-page":"47","article-title":"Cancer incidence and mortality in China, 2022","volume":"4","author":"Han","year":"2024","journal-title":"J Natl Cancer Cent"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib8","first-page":"12","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"10.1016\/j.ejso.2025.111362_bib9","doi-asserted-by":"crossref","DOI":"10.1016\/j.cpsurg.2025.101741","article-title":"Prognostic value of lymph node dissection count in esophageal squamous cell carcinoma: a systematic review and meta-analysis","volume":"66","author":"A-Lai","year":"2025","journal-title":"Curr Probl Surg"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib10","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s12885-022-09207-x","article-title":"Postoperative survival effect of the number of examined lymph nodes on esophageal squamous cell carcinoma with pathological stage T1-3N0M0","volume":"22","author":"Wu","year":"2022","journal-title":"BMC Cancer"},{"issue":"5","key":"10.1016\/j.ejso.2025.111362_bib11","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.21037\/jgo-20-371","article-title":"Prognostic impact of lymph node harvest for patients with node-negative esophageal squamous cell carcinoma: a large-scale multicenter study","volume":"12","author":"Shang","year":"2021","journal-title":"J Gastrointest Oncol"},{"issue":"2","key":"10.1016\/j.ejso.2025.111362_bib12","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/SLA.0000000000004798","article-title":"Impact of lymph node dissection on survival after neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma: from the results of NEOCRTEC5010, a randomized multicenter study","volume":"277","author":"Guo","year":"2023","journal-title":"Ann Surg"},{"issue":"6","key":"10.1016\/j.ejso.2025.111362_bib13","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1245\/s10434-020-09217-8","article-title":"Impact of examined lymph node count for esophageal squamous cell carcinoma in patients who underwent right transthoracic esophagectomy","volume":"28","author":"Zheng","year":"2021","journal-title":"Ann Surg Oncol"},{"issue":"7","key":"10.1016\/j.ejso.2025.111362_bib14","doi-asserted-by":"crossref","first-page":"855","DOI":"10.6004\/jnccn.2019.0033","article-title":"Esophageal and esophagogastric junction cancers, version 2.2019, NCCN clinical practice guidelines in oncology","volume":"17","author":"Ajani","year":"2019","journal-title":"J Natl Compr Cancer Netw"},{"key":"10.1016\/j.ejso.2025.111362_bib15","article-title":"Prognostic significance of lymph node ratio in esophageal squamous cell carcinoma: insights from the South Asian population","volume":"14","author":"Qureshi","year":"2024","journal-title":"Front Oncol"},{"key":"10.1016\/j.ejso.2025.111362_bib16","doi-asserted-by":"crossref","first-page":"38804","DOI":"10.1038\/srep38804","article-title":"Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy","volume":"6","author":"Zhang","year":"2016","journal-title":"Sci Rep"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib17","doi-asserted-by":"crossref","first-page":"159","DOI":"10.17305\/bb.2023.9435","article-title":"Lymph node ratio is a prognostic indicator for locally advanced esophageal squamous cell carcinoma after neoadjuvant immunochemotherapy","volume":"24","author":"Chen","year":"2024","journal-title":"Biomol Biomed"},{"issue":"2","key":"10.1016\/j.ejso.2025.111362_bib18","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1097\/JS9.0000000000002188","article-title":"Development and validation of a predictive model for overall survival in esophageal squamous cell carcinoma post-esophagectomy: the role of lymph node metastatic stations","volume":"111","author":"Li","year":"2025","journal-title":"Int J Surg"},{"issue":"6","key":"10.1016\/j.ejso.2025.111362_bib19","doi-asserted-by":"crossref","first-page":"3794","DOI":"10.1245\/s10434-024-15019-z","article-title":"Impact of metastatic lymph nodes on survival of patients with pN1-Category esophageal squamous cell carcinoma: a long-term survival analysis","volume":"31","author":"Li","year":"2024","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"10.1016\/j.ejso.2025.111362_bib20","doi-asserted-by":"crossref","first-page":"3584","DOI":"10.1245\/s10434-024-15176-1","article-title":"Do nodal disease patterns and approach to lymphadenectomy affect survival in patients with esophageal squamous cell carcinoma? Reinvigorating an age-old debate","volume":"31","author":"Florea","year":"2024","journal-title":"Ann Surg Oncol"},{"issue":"10","key":"10.1016\/j.ejso.2025.111362_bib21","doi-asserted-by":"crossref","first-page":"110362","DOI":"10.1016\/j.ejso.2025.110362","article-title":"Enhancing prognostic accuracy in gastric cancer: the TNrrM staging system versus the AJCC TNM system","volume":"51","author":"Zhang","year":"2025","journal-title":"Eur J Surg Oncol"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib22","first-page":"1","article-title":"Japanese classification of esophageal cancer","volume":"14","year":"2017","journal-title":"part I Esophagus"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib23","first-page":"37","article-title":"Japanese classification of esophageal cancer","volume":"14","year":"2017","journal-title":"part II and III Esophagus"},{"issue":"3","key":"10.1016\/j.ejso.2025.111362_bib24","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/SLA.0000000000002304","article-title":"Early oral feeding following McKeown minimally invasive esophagectomy: an open-label, randomized, controlled, noninferiority trial","volume":"267","author":"Sun","year":"2018","journal-title":"Ann Surg"},{"issue":"3","key":"10.1016\/j.ejso.2025.111362_bib25","doi-asserted-by":"crossref","first-page":"S60","DOI":"10.1016\/j.jtcvs.2011.12.051","article-title":"Minimally invasive ivor lewis esophagectomy","volume":"144","author":"Wee","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"8","key":"10.1016\/j.ejso.2025.111362_bib26","doi-asserted-by":"crossref","first-page":"4519","DOI":"10.1245\/s10434-020-09451-0","article-title":"Impact of lymph node ratio on survival outcome in esophageal squamous cell carcinoma after minimally invasive esophagectomy","volume":"28","author":"Kitamura","year":"2021","journal-title":"Ann Surg Oncol"},{"issue":"4","key":"10.1016\/j.ejso.2025.111362_bib27","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/JTO.0b013e3182829e2c","article-title":"Prognostic factors and outcome for patients with esophageal squamous cell carcinoma underwent surgical resection alone: evaluation of the seventh edition of the American joint committee on cancer staging system for esophageal squamous cell carcinoma","volume":"8","author":"Chen","year":"2013","journal-title":"J Thorac Oncol"},{"issue":"6","key":"10.1016\/j.ejso.2025.111362_bib28","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1007\/s00268-011-1015-9","article-title":"The N-classification for esophageal cancer staging: should it be based on number, distance, or extent of the lymph node metastasis?","volume":"35","author":"Xu","year":"2011","journal-title":"World J Surg"},{"issue":"2","key":"10.1016\/j.ejso.2025.111362_bib29","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/SLA.0b013e31815aaadf","article-title":"The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent","volume":"247","author":"Mariette","year":"2008","journal-title":"Ann Surg"},{"key":"10.1016\/j.ejso.2025.111362_bib30","article-title":"Evolution of lymph node staging in esophageal squamous cell carcinoma: insights from lymph node metastatic stations","volume":"15","author":"Li","year":"2025","journal-title":"Front Oncol"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib31","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s12885-024-11886-7","article-title":"Increased resected lymph node stations improved survival of esophageal squamous cell carcinoma","volume":"24","author":"Lu","year":"2024","journal-title":"BMC Cancer"},{"issue":"3","key":"10.1016\/j.ejso.2025.111362_bib32","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s10388-023-00993-2","article-title":"Esophageal cancer practice guidelines 2022 edited by the Japan esophageal society: part 1","volume":"20","author":"Kitagawa","year":"2023","journal-title":"Esophagus"},{"issue":"3","key":"10.1016\/j.ejso.2025.111362_bib33","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s10388-023-00994-1","article-title":"Esophageal cancer practice guidelines 2022 edited by the Japan Esophageal Society: part 2","volume":"20","author":"Kitagawa","year":"2023","journal-title":"Esophagus"},{"issue":"7","key":"10.1016\/j.ejso.2025.111362_bib34","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1002\/jso.24758","article-title":"Lymph node station ratio: revised nodal category for resected esophageal squamous cell carcinoma patients","volume":"116","author":"Fu","year":"2017","journal-title":"J Surg Oncol"},{"issue":"12","key":"10.1016\/j.ejso.2025.111362_bib35","doi-asserted-by":"crossref","first-page":"4045","DOI":"10.1245\/s10434-019-07601-7","article-title":"Lymph node station-based nodal staging system for esophageal squamous cell carcinoma: a large-scale multicenter study","volume":"26","author":"Yuan","year":"2019","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib36","doi-asserted-by":"crossref","first-page":"e43","DOI":"10.1097\/SLA.0000000000005627","article-title":"Ten-year survival and recurrence patterns after three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus","volume":"278","author":"Altorki","year":"2023","journal-title":"Ann Surg"},{"issue":"3","key":"10.1016\/j.ejso.2025.111362_bib37","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/BF01627708","article-title":"Lymphatic drainage of the esophagus in the adult","volume":"15","author":"Riquet","year":"1993","journal-title":"Surg Radiol Anat"},{"issue":"6","key":"10.1016\/j.ejso.2025.111362_bib38","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1016\/S0022-5223(03)00036-9","article-title":"Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus","volume":"125","author":"Kuge","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"10.1016\/j.ejso.2025.111362_bib39","doi-asserted-by":"crossref","first-page":"5415","DOI":"10.1038\/s41598-025-89340-2","article-title":"Application of network analysis and association rule mining for visualizing the lymph node metastasis patterns in esophageal squamous cell carcinoma","volume":"15","author":"Baek","year":"2025","journal-title":"Sci Rep"}],"container-title":["European Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0748798325017901?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0748798325017901?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T02:32:38Z","timestamp":1783737158000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0748798325017901"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["S0748798325017901"],"URL":"https:\/\/doi.org\/10.1016\/j.ejso.2025.111362","relation":{},"ISSN":["0748-7983"],"issn-type":[{"value":"0748-7983","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"SRRN: A regional lymph node ratio\u2013based staging system enhancing prognostic accuracy in esophageal squamous cell carcinoma","name":"articletitle","label":"Article Title"},{"value":"European Journal of Surgical Oncology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ejso.2025.111362","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"111362"}}