Prognostic value of lymph node micrometastasis in esophageal cancer: A systematic review and meta-analysis

Jing Yang; Qianqian Liu; Yuping Bai; Haitong Zhao; Tingting He; Ziru Zhao; Min Huang; Mengyuan Jiang; Rui Zhang; Min Zhang

doi:10.3389/fonc.2022.1025855

Prognostic value of lymph node micrometastasis in esophageal cancer: A systematic review and meta-analysis

Front Oncol. 2023 Jan 4:12:1025855. doi: 10.3389/fonc.2022.1025855. eCollection 2022.

Authors

Jing Yang^{1

2

3}, Qianqian Liu^{1

2

3}, Yuping Bai^{1

2

4}, Haitong Zhao⁵, Tingting He^{1

2

3}, Ziru Zhao^{1

2

3}, Min Huang^{1

2

3}, Mengyuan Jiang^{1

2

3}, Rui Zhang^{1

2

3}, Min Zhang^{1

2}

Affiliations

¹ School of Basic Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China.
² Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu, China.
³ Department of Pathology, The 940th Hospital of Joint Logistics Support Force of Chinese People´s Liberation Army, Lanzhou, China.
⁴ The Department of Pathology, Hainan Provincial Hospital, Haikou, Hainan, China.
⁵ Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.

Abstract

Objective: Whether lymph node micrometastasis (LNM) increases the risk in esophageal cancer patients remains controversial. We conducted a systematic review and meta-analysis to explore the prognosis value of LNM in esophageal cancer patients.

Methods: Two reviewers independently searched electronic databases, including PubMed, Embase, and the Cochrane Library, for eligible citations until February 2022. We calculated pooled estimates of the hazards ratio with a random-effects model. The certainty of evidence was determined by the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) method. A sensitivity analysis was performed to assess the stability. Publication bias was assessed using funnel plots and Egger's test. We also performed subgroup analysis to explore the source of heterogeneity.

Results: A total of 16 studies, with 1,652 patients, were included. The overall survival (OS) was significantly increased with LNM negativity compared with LNM positivity (HR 1.95; 95% CI, 1.53-2.49; P < 0.001; I² = 0.0%, P = 0.930; certainty of evidence: low). Relapse-free survival (RFS) was significantly increased with LNM negativity compared with LNM positivity (HR 3.39; 95% CI, 1.87-6.16; P < 0.001; I² = 50.18%, P = 0.060; certainty of evidence: moderate). No significant difference was observed in recurrence between the two groups (certainty of evidence: low). Sensitivity analysis revealed a stable trend. In addition, the funnel plot and Egger's test did not show significant publication bias.

Conclusion: LNM positivity worsens the prognosis in esophageal cancer, and the evidence for RFS is moderate. Future relevant high-quality studies are warranted to validate our results further and provide a reference for guidelines.

Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier (CRD42022321768).

Keywords: esophageal cancer; lymph node micrometastasis; meta-analysis; prognosis; systematic review.

Publication types

Systematic Review