{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T01:16:53Z","timestamp":1778807813193,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lymph node dissection is crucial for accurate staging and prognosis assessment in esophageal squamous cell carcinoma (ESCC). While sufficient examined lymph nodes (ELNs) are generally linked to better outcomes, how ELN count affects prognosis under immunotherapy remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study analyzed 621 ESCC patients who underwent R0 resection with or without neoadjuvant chemo\u2010immunotherapy (NACI). Patients were stratified into surgery alone (SA) (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009451) and NACI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009170) groups. Propensity score matching balanced baseline characteristics. The relationship between ELN count and overall survival was analyzed using Cox regression models. Single\u2010cell RNA and T\u2010cell receptor sequencing were performed on paired tumor and lymph node samples to elucidate underlying immune mechanisms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the NACI cohort, both insufficient (ELN\u2009\u2264\u200923) and excessive (ELN\u2009&gt;\u200931) lymph node resection were independent risk factors for worse overall survival (ELN\u2009\u2264\u200923: HR\u2009=\u20092.29, 95% CI 1.11\u20134.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024; ELN\u2009&gt;\u200931: HR\u2009=\u20092.71, 95% CI 1.17\u20136.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020). However, the SA cohort derived continuous survival benefit from higher ELN counts. Single\u2010cell sequencing revealed that NACI enriched a population of activated, tumor\u2010reactive cytotoxic T cells within metastasis\u2010negative lymph nodes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The optimal ELN count is contingent on treatment strategy. For SA, a more extensive lymphadenectomy improves survival. However, for NACI, a \u201cGoldilocks\u201d principle applies\u2014an ELN count between 24 and 31 balances accurate staging with the preservation of antitumor immunity, advocating for function\u2010preserving, personalized surgery in the immunotherapy era.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1759-7714.70297","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:30:32Z","timestamp":1778153432000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tailoring the Extent of Lymphadenectomy for Esophageal Squamous Cell Carcinoma: Insights From a Comparative Study of Neoadjuvant Chemo\u2010Immunotherapy and Surgery Cohort"],"prefix":"10.1111","volume":"17","author":[{"given":"Kunheng","family":"Du","sequence":"first","affiliation":[{"name":"Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongwei","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery The First Affiliated Hospital of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenyi","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziyu","family":"Ning","sequence":"additional","affiliation":[{"name":"Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiahui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changhong","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3328-6792","authenticated-orcid":false,"given":"Haiyu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3296-9759","authenticated-orcid":false,"given":"Zaiyi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0916-3407","authenticated-orcid":false,"given":"Yihuai","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University  Guangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.05.054"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cac2.12645"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doad065"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2022.106764"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2022.106628"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00262\u2010025\u201004168\u2010z"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/15330338241231610"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/kjm2.12793"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1759\u20107714.15291"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000001594"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010019\u201007870\u20102"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885\u2010022\u201009207\u2010x"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005028"},{"key":"e_1_2_13_15_1","article-title":"NCCN 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