{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T08:58:15Z","timestamp":1783414695095,"version":"3.54.6"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":56,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Zhejiang Provincial Natural Science Foundation of China","award":["LTGY23H160011"],"award-info":[{"award-number":["LTGY23H160011"]}]},{"name":"Zhejiang Provincial Natural Science Foundation of China","award":["LTGY24H010003"],"award-info":[{"award-number":["LTGY24H010003"]}]},{"name":"Program of Province TCM Sci-Tech Plan","award":["2024ZL298"],"award-info":[{"award-number":["2024ZL298"]}]},{"DOI":"10.13039\/100007219","name":"Shanghai Natural Science Foundation","doi-asserted-by":"publisher","award":["25ZR1402449"],"award-info":[{"award-number":["25ZR1402449"]}],"id":[{"id":"10.13039\/100007219","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Cervical lymph node metastasis in thoracic esophageal cancer occupies a conceptual border zone between locoregional and distant disease. Evidence guiding treatment selection in this population remains limited in Western cohorts. The objective was to evaluate treatment strategies and overall survival outcomes for patients with resectable esophageal cancer and concurrent cervical lymph node metastasis in the Netherlands. This population-based cohort study used the Netherlands Cancer Registry to identify patients with resectable thoracic esophageal or gastroesophageal junction cancer and concurrent cervical lymph node metastasis. Treatment strategies included definitive chemoradiotherapy, neoadjuvant therapy followed by surgery, chemotherapy with or without limited radiotherapy (\u226430\u00a0Gy), palliative radiotherapy, and best supportive care. Kaplan\u2013Meier analysis and Cox regression adjusted with inverse probability of treatment weighting (IPTW) were used to assess overall survival and treatment effects. Between 2015 and 2021, 412 eligible patients were identified. Median overall survival was 24\u00a0months for patients treated with neoadjuvant therapy followed by surgery, 18\u00a0months for definitive chemoradiotherapy, 15\u00a0months for chemotherapy, 7\u00a0months for radiotherapy alone, and 3\u00a0months for best supportive care. In multivariable analysis, neoadjuvant therapy followed by surgery was associated with longer survival compared with definitive chemoradiotherapy (HR 0.56 [0.34\u20130.91]). Similar estimates were observed after IPTW. Higher cN stage and poorer performance status were independently associated with worse survival. Subgroup analysis of neoadjuvant chemoradiotherapy versus chemotherapy within the surgical cohort showed no significant survival difference. In this nationwide cohort, management of thoracic esophageal cancer with concurrent cervical lymph node metastasis was highly heterogeneous. Although neoadjuvant therapy followed by surgery was associated with longer survival, interpretation is limited by baseline differences and potential residual confounding. These findings suggest that surgery may be considered within a multimodality strategy in carefully selected patients and warrant prospective evaluation to better define its role.<\/jats:p>","DOI":"10.1093\/dote\/doag040","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T11:29:40Z","timestamp":1775561380000},"source":"Crossref","is-referenced-by-count":1,"title":["Treatment strategies of esophageal cancer with concurrent cervical node metastasis: a Dutch nationwide population-based cohort study"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3896-5234","authenticated-orcid":false,"given":"Maxime E","family":"Sanders","sequence":"first","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]},{"name":"Department of Radiation Oncology, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"van der Horst","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teus J","family":"Weijs","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Erik","family":"Freund","sequence":"additional","affiliation":[{"name":"Department of Pathology, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Mook","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4688-2921","authenticated-orcid":false,"given":"Nadia Haj","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5193-0820","authenticated-orcid":false,"given":"Bianca","family":"Mostert","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Erasmus Medical Center , Rotterdam, South Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4738-3697","authenticated-orcid":false,"given":"Bas P L","family":"Wijnhoven","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus Medical Center , Rotterdam, South Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grard A P","family":"Nieuwenhuijzen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Catharina Hospital , Eindhoven, North Brabant ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke W M","family":"van Laarhoven","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Amsterdam University Medical Center , Amsterdam, North Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8689-3134","authenticated-orcid":false,"given":"Mark I","family":"van Berge Henegouwen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam University Medical Center , Amsterdam, North Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9483-1520","authenticated-orcid":false,"given":"Misha D P","family":"Luyer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Catharina Hospital , Eindhoven, North Brabant ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter C","family":"van der Sluis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus Medical Center , Rotterdam, South Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob H A","family":"Verhoeven","sequence":"additional","affiliation":[{"name":"Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL) , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjoerd M","family":"Lagarde","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus Medical Center , Rotterdam, South Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne S","family":"Gisbertz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam University Medical Center , Amsterdam, North Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelle P","family":"Ruurda","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7134-261X","authenticated-orcid":false,"given":"Richard","family":"van Hillegersberg","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"issue":"3","key":"2026042707440066300_ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"22","key":"2026042707440066300_ref2","doi-asserted-by":"publisher","first-page":"2074","DOI":"10.1056\/nejmoa1112088","article-title":"Preoperative Chemoradiotherapy for Esophageal or junctional cancer","volume":"366","author":"Hagen","year":"2012","journal-title":"New Engl J Med"},{"issue":"18","key":"2026042707440066300_ref3","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1200\/JCO.20.03614","article-title":"Ten-year outcome of neoadjuvant Chemoradiotherapy plus surgery for Esophageal cancer: the randomized controlled CROSS trial","volume":"39","author":"Eyck","year":"2021","journal-title":"J Clin Oncol"},{"issue":"4","key":"2026042707440066300_ref4","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1056\/NEJMoa2409408","article-title":"Perioperative chemotherapy or preoperative Chemoradiotherapy in Esophageal cancer","volume":"392","author":"Hoeppner","year":"2025","journal-title":"N Engl J Med"},{"issue":"2","key":"2026042707440066300_ref5","doi-asserted-by":"publisher","first-page":"119","DOI":"10.21037\/ACS.2017.03.14","article-title":"8th edition AJCC\/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice","volume":"6","author":"Rice","year":"2017","journal-title":"Ann Cardiothorac Surg"},{"issue":"1","key":"2026042707440066300_ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10388-016-0551-7","article-title":"Japanese classification of Esophageal cancer, 11th edition: part I","volume":"14","year":"2017","journal-title":"Esophagus."},{"issue":"1","key":"2026042707440066300_ref7","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s10388-016-0556-2","article-title":"Japanese classification of Esophageal cancer, 11th edition: part II and III","volume":"14","year":"2017","journal-title":"Esophagus."},{"issue":"1\u20135","key":"2026042707440066300_ref8","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1007\/bf02022621","article-title":"Ueber die Lymphgef\u00e4sse des oesophagus und \u00fcber seine region\u00e4ren Lymphdr\u00fcsen mit Ber\u00fccksichtigung der Verbreitung des Carcinoms","volume":"1","year":"1904","journal-title":"J Cancer Res Clin Oncol"},{"key":"2026042707440066300_ref9","doi-asserted-by":"publisher","first-page":"6295","DOI":"10.2147\/CMAR.S182436","article-title":"Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer","volume":"10","author":"Wang","year":"2018","journal-title":"Cancer Manag Res"},{"key":"2026042707440066300_ref10","doi-asserted-by":"publisher","first-page":"S724","DOI":"10.21037\/jtd.2017.06.19","article-title":"Pattern of lymph node metastases of squamous cell esophageal cancer based on the anatomical lymphatic drainage system: efficacy of lymph node dissection according to tumor location","volume":"9","author":"Tachimori","year":"2017","journal-title":"J Thorac Dis"},{"issue":"12","key":"2026042707440066300_ref11","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"12","author":"Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"11","key":"2026042707440066300_ref12","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.1016\/j.dld.2019.05.014","article-title":"Different prognosis of patients with esophageal carcinoma with M1a and regional node involvement","volume":"51","author":"Chung","year":"2019","journal-title":"Dig Liver Dis"},{"issue":"6","key":"2026042707440066300_ref13","doi-asserted-by":"publisher","first-page":"349","DOI":"10.21037\/atm-22-577","article-title":"Neoadjuvant therapy combined with surgery is superior to chemoradiotherapy in esophageal squamous cell cancer patients with resectable supraclavicular lymph node metastasis: a propensity score-matched analysis","volume":"10","author":"Yu","year":"2022","journal-title":"Ann Transl Med"},{"issue":"7","key":"2026042707440066300_ref14","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.1245\/s10434-010-1024-1","article-title":"7th edition of the AJCC cancer staging manual: Esophagus and Esophagogastric junction","volume":"17","author":"Rice","year":"2010","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"2026042707440066300_ref15","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1245\/S10434-023-14562-5","article-title":"Significance of surgery for Resectable M1 lymph node metastases without organ metastasis in Esophageal carcinoma in the era of neoadjuvant treatment","volume":"31","author":"Igaue","year":"2023","journal-title":"Ann Surg Oncol"},{"key":"2026042707440066300_ref16","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1111\/1754-9485.13561","article-title":"Neoadjuvant chemoradiotherapy followed by oesophagectomy may be the optimal treatment option for lower thoracic oesophageal cancer with supraclavicular lymph node metastasis: an inverse probability of treatment-weighted analysis of SEER database","volume":"67","author":"Chang","year":"2023","journal-title":"J Med Imaging Radiat Oncol"},{"issue":"4","key":"2026042707440066300_ref17","doi-asserted-by":"publisher","first-page":"462","DOI":"10.3892\/OL.2024.14595","article-title":"Supraclavicular lymph node metastasis should not be defined as regional lymph node metastasis in cervical and upper thoracic esophageal squamous cell carcinoma","volume":"28","author":"Zeng","year":"2024","journal-title":"Oncol Lett"},{"issue":"1","key":"2026042707440066300_ref18","doi-asserted-by":"publisher","first-page":"15073","DOI":"10.1038\/s41598-018-33400-3","article-title":"Neck lymph node metastasis as a poor prognostic factor in thoracic Esophageal squamous cell carcinoma patients receiving concurrent Chemoradiotherapy: a propensity score-matched analysis","volume":"8","author":"Chen","year":"2018","journal-title":"Sci Rep"},{"key":"2026042707440066300_ref19","doi-asserted-by":"publisher","first-page":"2743","DOI":"10.1245\/s10434-022-12996-x","article-title":"Safety and feasibility of robot-assisted minimally invasive Esophagectomy (RAMIE) with three-field lymphadenectomy and neoadjuvant Chemoradiotherapy in patients with Resectable Esophageal cancer and cervical lymph node metastasis","volume":"30","author":"Horst","year":"2023","journal-title":"Ann Surg Oncol"}],"container-title":["Diseases of the Esophagus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/39\/2\/doag040\/68164856\/doag040.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/39\/2\/doag040\/68164856\/doag040.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T11:44:09Z","timestamp":1777290249000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dote\/article\/doi\/10.1093\/dote\/doag040\/8663001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1093\/dote\/doag040","relation":{},"ISSN":["1120-8694","1442-2050"],"issn-type":[{"value":"1120-8694","type":"print"},{"value":"1442-2050","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,2]]},"article-number":"doag040"}}