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Positive circumferential resection margin in locally advanced esophageal cancer: an updated systematic review and meta-analysis

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Abstract

Background

The impact of positive circumferential resection margin on prognosis in esophageal cancer is under controversy. Previous systematic reviews and meta-analyses had limitations. This updated systematic review and meta-analysis aimed to assess the prognostic impact of positive circumferential resection margin in esophageal cancer.PubMed and Web of Science were searched for studies investigating the association between circumferential resection margin status and prognosis in esophageal cancer. Study population were focused on T3 and/or T4a patients. Study selection was based on availability of survival information (Kaplan–Meier curves and adjusted analysis). Random-effects models were used to summarize hazard ratios for overall survival and disease-free survival.According to College of American Pathologists criteria, circumferential resection margin-positive patients had shorter median overall survival (P < 0.0001) and shorter median disease-free survival (P < 0.0001) compared with circumferential resection margin-negative patients. The pooled hazard ratios for overall survival and disease-free survival were 2.06 (95% confidence interval, 1.68–2.53; P < 0.0001) and 2.00 (95% confidence interval, 1.41–2.84; P < 0.0001), respectively. According to the Royal College of Pathologists criteria, circumferential resection margin-positive patients had shorter median overall survival (P < 0.0001) and shorter median disease-free survival (P < 0.0001) compared with circumferential resection margin-negative patients. The pooled hazard ratios for overall survival and disease-free survival were 1.31 (95% confidence interval, 1.16–1.48; P < 0.0001) and 1.31 (95% confidence interval, 1.09–1.57; P < 0.0001), respectively.ompared with negative circumferential resection margin, positive circumferential resection margin is associated with worse survival outcomes in esophageal cancer.

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Data availability

All data generated or analyzed in this study are included in this manuscript.

Abbreviations

CAP:

College of American Pathologists

CI:

Confidence interval

CRM:

Circumferential resection margin

DFS:

Disease-free survival

HR:

Hazard ratio

OS:

Overall survival

RCP:

The Royal College of Pathologists

ROBINS-I:

Risk of bias in nonrandomized studies of interventions

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

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Authors and Affiliations

  1. Department of Thoracic Surgery, Institute of Basic Medicine and Cancer (IBMC), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Chinese Academy of Sciences, 1 East Banshan Rd, Hangzhou, 310022, China

    Jie Wu, Yuqian Hu & Liwei Xu

  2. Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Beijing, China

    Jie Wu, Yuqian Hu & Liwei Xu

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  1. Jie Wu
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Contributions

WJ conceived this study, collected data, performed analysis and drafted the manuscript. HY collected data, performed analysis and helped to draft the manuscript. XL collected data, performed analysis and helped to draft the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jie Wu.

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This is a review study which has been conducted in accordance with the ethical standards as laid in the 1964 Helsinki Declaration.

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Wu, J., Hu, Y. & Xu, L. Positive circumferential resection margin in locally advanced esophageal cancer: an updated systematic review and meta-analysis. Updates Surg 74, 1187–1197 (2022). https://doi.org/10.1007/s13304-022-01256-y

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