A new lymph node ratio-based staging system improves survival prediction for esophageal squamous cell carcinoma (ESCC).

• The proposed SRRN system correlates with 5-year overall survival rates: 66.7% for SRRN0 vs. 7.9% for SRRN3.
• SRRN outperforms traditional N staging, showing higher accuracy in both Cox and RSF models, enhancing prognostic reliability.

This method could refine patient selection and tailor treatment strategies, optimizing surgical outcomes.

• Nomograms using SRRN demonstrate strong calibration, indicating their practical clinical application.