Jiang KY, Huang H, Chen WY, Yan HJ, Wei ZT, Wang XW, Li HX, Zheng XY, Tian D. Risk factors for lymph node metastasis in T1 esophageal squamous cell carcinoma: A systematic review and meta-analysis. World J Gastroenterol 2021; 27(8): 737-750 [PMID: 33716451 DOI: 10.3748/wjg.v27.i8.737]
Corresponding Author of This Article
Dong Tian, MD, PhD, Doctor, Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, No. 63 Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China. 22tiandong@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kai-Yuan Jiang, Heng Huang, Wei-Yang Chen, Hao-Ji Yan, Zhen-Ting Wei, Xiao-Wen Wang, Hao-Xuan Li, Xiang-Yun Zheng, College of Clinical Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Kai-Yuan Jiang, Dong Tian, Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Author contributions: Jiang KY, Huang H and Tian D designed the research; Jiang KY and Huang H performed the research and drafted the article; Chen WY, Yan HJ and Wei ZT screened the literature and collected the data; Wang XW, Li HX and Zheng XY analyzed the data and interpreted the data; Tian D revised the article; All authors have read and approved the final manuscript; Jiang KY and Huang H contributed equally to this work.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Tian, MD, PhD, Doctor, Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, No. 63 Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China. 22tiandong@163.com
Received: November 28, 2020 Peer-review started: November 28, 2020 First decision: January 17, 2021 Revised: January 20, 2021 Accepted: February 1, 2021 Article in press: February 1, 2021 Published online: February 28, 2021 Processing time: 90 Days and 1.2 Hours
ARTICLE HIGHLIGHTS
Research background
Endoscopic resection has been increasingly used in patients with T1 esophageal squamous cell carcinoma (ESCC). However, lymph node metastasis (LNM) has been widely reported in patients with T1 ESCC, and some studies have even found higher rates of metastasis. Endoscopic resection for T1 ESCC should be carefully considered.
Research motivation
Endoscopic resection is not appropriate for patients with a potential risk of LNM and the risk of metastasis must be assessed in advance to make the right decision. In addition, reports of the risk factors for LNM have been controversial.
Research objectives
The purpose of this meta-analysis was to assess risk factors of LNM for patients with T1 ESCC.
Research methods
We conducted a comprehensive search of multiple electronic databases including PubMed, EMBASE and the Cochrane Library to select studies related to the topics. Statistical analysis was conducted via comprehensive meta-analysis software.
Research results
A total of 3775 patients with T1 ESCC from 17 studies were included. The rates of LNM in T1a and T1b were 5.4% and 33.7%, respectively. Tumor size > 2 cm, lower tumor location, nonflat macroscopic type, T1b stage, poor differentiation and lymphovascular invasion were found to be significantly associated with LNM. Conversely, sex, age and infiltrative growth pattern were not identified as risk factors for LNM.
Research conclusions
This meta-analysis is the first to comprehensively evaluate LNM only in ESCC patients with T1 stage. For patients with a potential high risk of LNM, radical esophagectomy is superior to endoscopic resection, and potential metastatic lymph nodes can be dissected.
Research perspectives
All included studies were performed in Asian countries (China, Japan and South Korea), and the results may therefore be influenced by ethnicity. There is still a need to include data from other continents.
