In view of the current research status of the 7th edition of AJCC staging of esophageal cancer, some views are published for the reference of colleagues only, taking into account our research situation. Is supraclavicular regional lymph node metastasis an N-stage? In the 7th edition of AJCC esophageal cancer staging published in 2009, all peri-esophageal lymph nodes within the range from the neck to the abdominal trunk were defined as regional lymph nodes, and the M1a and M1b subgroup stages (i.e. non-regional lymph nodes in the supraclavicular region and abdominal trunk lymph nodes) of the M1 staging in the 6th edition of AJCC esophageal cancer staging were eliminated, stipulating that zone 1 (supraclavicular regional lymph nodes) included the lower neck , supraclavicular and suprasternal lymph nodes on the sternotomy. The prognosis and staging of supraclavicular lymph node metastases have been controversial. However, most scholars believe that the prognosis of supraclavicular lymph nodes is better than that of hematogenous metastases and should be classified as N-stage rather than M-stage. The 5-year survival rate of patients with supraclavicular lymph node positive esophageal squamous carcinoma after three-field lymph node dissection was reported as 27.2% by Lerut et al; 20.0% by Fang et al; and 43.8% at 3 years by Tachimori et al. (Kato et al. reported 197 patients who underwent radical surgery for esophageal cancer in three fields, and the prognosis of supraclavicular lymph node metastasis was better. The prognosis of supraclavicular lymph node metastasis was better than that of hematogenous metastasis (P = 0.002), and there was no significant difference in survival curves between supraclavicular and mediastinal and abdominal lymph node metastasis in patients without distant organ metastasis (P = 0.127, P = 0.155). In an analysis of 480 patients with postoperative esophageal cancer, Rice et al. showed a significant difference in survival between patients with M0 and M1 stages (P < 0.0001), but patients with M1a and M1b stages did not show a difference in survival (P = 0.9). We retrospectively analyzed 547 patients with supraclavicular regional lymph node metastasis in 1715 patients with three-field radical surgery for squamous esophageal carcinoma of the thoracic segment, and the results showed that the 5-year overall survival rate of the whole group after surgery for squamous esophageal carcinoma of the thoracic segment with supraclavicular regional lymph node metastasis was 27.7%, including 21.3% and 34.2% in the surgery-only group and the postoperative radiotherapy group, respectively (P < 0.001); in the surgery-only group, the 5-year survival rate of the upper, middle and The 5-year overall survival rates were 17.7%, 22.5% and 31.7% in the upper, middle and lower thoracic esophageal cancer groups, respectively (P = 0.112), which were approximately the same as those reported in the literature and supported the classification of supraclavicular regional lymph node metastasis as regional lymph nodes in the 7th edition of AJCC esophageal cancer staging. Whether the field number of lymph node metastasis area was used as the N staging criterion The biggest modification in the 7th edition of AJCC esophageal cancer staging was the number of lymph node metastases as the N staging criterion: N1 for l-2 regional lymph node metastases; N2 for 3-6 regional lymph node metastases; and N3 for ≥7 regional lymph node metastases, and most authors now support this staging. We analyzed 590 patients with lymph node-positive thoracic segment esophageal squamous carcinoma by simple three-field radical surgery according to the 7th edition AJCC staging criteria, and the 5-year survival rates of IIb, IIIa, IIIb and IIIc were 50.8%, 37.7%, 21.3% and 14.3%, respectively (P < 0.0001), which also supported the 7th edition AJCC staging. In recent years, some authors have proposed the number of lymph node metastatic areas as an N-staging criterion. An Fengshan et al. reported 217 patients undergoing three-field radical resection for esophageal squamous carcinoma in the thoracic segment were divided into four groups according to the number of lymph node metastases: the group with no lymph node metastases, the group with lymph node metastases in one of the three regions of the neck, chest and abdomen, the group with lymph node metastases in two regions, and the group with lymph node metastases in all three regions. As the number of lymph node metastases increased, the survival rate of patients gradually decreased, and the number of lymph node metastases was an independent prognostic factor. Similarly, Shimada et al. reported 5-year survival rates of 69%, 50%, 29%, and 11% in 200 patients with three-field radical resection of esophageal squamous carcinoma of the thoracic segment with 0, 1, 2, and 3 lymph node metastasis areas, respectively (P < 0.001), suggesting that the number of lymph node metastasis areas for N-staging is more reasonable. In our study of 590 patients with lymph node-positive thoracic segment esophageal squamous carcinoma undergoing simple three-field radical surgery, the 5-year survival rates were 41.6%, 19.9%, and 10.1% in the group with 1 regional lymph node metastasis in 3 regions of the cervicothorax and abdomen, the group with 2 regional lymph node metastasis, and the group with lymph node metastasis in all 3 regions, respectively (P < 0.001); further stratified analysis showed that the 5-year survival rates in the group with 1 In the group of those with one regional lymph node metastasis, the mean number of metastases in the supraclavicular, mediastinal, and abdominal regions was 3.3, 1.8, and 3.2, respectively, and their 5-year survival rates were 34.5%, 39.8%, and 52.5%, respectively (P = 0.036); multifactorial analysis of tumor site and 7th edition N stage were independent prognostic factors for radical surgery of lymph node-positive squamous esophageal cancer of the thoracic segment (P < 0.001 ), while the number of lymph node metastatic areas was not an independent prognostic factor (P = 0.066). We believe that the number of lymph node metastatic areas cannot be simply equated with N1/N2/N3 in the 7th edition of N staging, pending validation of data from more centers.