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Objective: The 7th edition of the AJCC staging system classifies nodal stage by the number of malignant nodes found. This method may be confounded by variations in lymphadenectomy and specimen review. The ratio of lymph nodes containing metastases to the total nodes excised (LNR) has been suggested an alternative. Few studies of LNR have included patients undergoing preoperative chemoradiation. In this study, we seek to verify the validity of LNR for staging, especially in those treated with neoadjuvant therapy, compare it to the current AJCC system, and identify other variables affecting outcome.Methods: A review of our prospective esophageal database indentified 92 patients who underwent esophagectomy at out institution from 1988 until 2010 for esophageal cancer. Univariate and multivariate analysis were performed.Results: The mean age at diagnosis of our patients was 60.4. 79% were male. 47.8% had neoadjuvant therapy. Transthoracic esophagectomy was performed in all but 3 instances. 76% of the tumors were adenocarcinoma. 80.4% were located in the lower 3rd of the esophagus or the GE junction. Overall survival at 2 and 5 years was 52.5% and 19.7%. Univariate analysis identified a statistically non-significant worse disease specific survival in patients with adenocarcinoma (p=.207). Analysis was then carried forward in only the adeno cohort. Upon stratification by LNR, no significant difference was found (p=.373). Conversely, the N-1 group had worse DS survival then N-0 and N-2 (p=.011 and p=.002). Further stratification by neoadjuvant therapy showed worse survival in N-1 and 3 vs N-2 (p=.004 and .028) but not N-0 (p=.092 and .403) in the untreated group. No minimum number of nodes harvested produced additional relationships between survival, N-stage, and LNR. Multivariate analysis with a Cox regression including LNR, total nodes harvested, age, gender, race, T-Stage, N-Stage, tumor histology, tumor location, neoadjuvant therapy, adjuvant therapy, preop weight loss, and serum albumin showed LNR to be a significant predictor of DS mortality (p=.012). N1 stage was also associated with mortality (HR=6.8, p=.001), but N2 and N3 stages conferred a non-significant survival benefit (HR=.198, p=.062 and HR=.830, p=.798). Other predictors of mortality included high grade (HR=20.6, p=.009), alcohol use (HR=4.29, p=.004) and tobacco use (HR=5.84. p=.006). Conclusion: LNR was found to be a significant predictor of DS mortality in a cohort containing large numbers of patients treated with neoadjuvant therapy. However, neither a staging system based on LNR, nor its efficacy compared to the current staging system could be determined from this data.