Prognostic impact of recurrent laryngeal nerve lymph node metastatic status in thoracic esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) is a highly aggressive malignancy with poor prognosis, and lymph node metastasis significantly influences patient outcomes. This retrospective study analyzed 189 thoracic ESCC patients who underwent radical esophagectomy (2019-2021) to evaluate the prognostic role of recurrent laryngeal nerve lymph node metastasis (RLN LNM). Patients with RLN LNM showed significantly worse overall survival (OS, P = 0.01) and disease-free survival (DFS, P = 0.046) than those without metastasis, with a 50.53% higher mortality risk and 37.83% higher recurrence risk. Subgroup analysis revealed no survival differences between left- and right-sided RLN LNM (P>0.05), while bilateral RLN LNM trended toward poorer outcomes but without statistical significance. Patients with RLN LNM plus extranodal metastases had markedly reduced OS (P = 0.0014) and DFS (P = 0.0008) compared to isolated RLN LNM. RLN LNM significantly predicted poor prognosis in lower thoracic ESCC (OS: P = 0.0027; DFS: P = 0.037) but not in upper or middle thoracic tumors. Multivariate Cox regression identified RLN LNM, perineural invasion, lymphovascular invasion, and neoadjuvant chemoradiotherapy with immunotherapy as independent risk factors for OS. These findings highlight RLN LNM as a critical prognostic indicator, particularly for lower thoracic ESCC, and emphasize the importance of integrating RLN LNM status into treatment strategies and staging systems.