Tumour-Negative Lymph Node Size Emerges in Oesophagogastric Cancer: ESMO Gastrointestinal Oncology | August 2026

Introduction:

Lymph node metastasis is a major prognostic factor in oesophagogastric adenocarcinoma (OGAC), but tumour-negative lymph nodes (LNneg) have received little attention. This analysis of two major Phase III trials evaluated whether the size of nonmetastatic lymph nodes provides additional prognostic information after chemotherapy and surgery.

Why was this study needed?

Current staging focuses almost entirely on tumour-positive lymph nodes.

Tumour-negative nodes may reflect the host antitumour immune response.

Previous studies suggested larger LNnegs were associated with better survival but required independent validation.

A simple histological biomarker could improve postoperative risk stratification.

Results:

Among 1,367 patients from the OE05 and ST03 trials, larger tumour-negative lymph nodes were associated with lower recurrence and lower metastatic lymph-node burden.

Patients with a largest LNneg >10 mm had significantly better overall and progression-free survival.

LNneg size remained an independent prognostic factor after adjustment for established clinicopathological variables.

Oesophageal/junctional cancers had larger, more pigment-rich LNnegs than gastric cancers, suggesting anatomical and microenvironmental differences.

Clinical Impact:

Tumour-negative lymph nodes may contain valuable biological information currently overlooked in routine pathology. LNneg size is simple, inexpensive, and potentially measurable automatically on digital pathology slides, making it an attractive additional prognostic biomarker. Further studies should determine whether larger nodes truly reflect stronger antitumour immunity and whether this information can guide treatment or surveillance.

Bottom Line:

A tumour-negative lymph node >10 mm independently predicts better survival in resected oesophagogastric adenocarcinoma. Looking beyond metastatic nodes to the morphology of tumour-negative lymph nodes may provide a simple new window into host antitumour biology and prognosis.