Extracapsular lymph node involvement is a robust survival predictor in esophageal cancer patients: A pooled analysis.

Abstract

BACKGROUND\nAlthough extracapsular lymph node involvement (EC-LNI) has been proposed to be incorporated into the staging system of esophageal cancer, the prognostic value of EC-LNI remains controversial with conflicting data available, especially in the era of neoadjuvant therapy.\n\n\nMETHODS\nAn electronic literature search was undertaken using four public databases. Studies investigating the effects of EC-LNI on survival were included. In addition to analysis of the entire cohort, subset analyses were also performed to assess the impact of EC-LNI on patients receiving different treatment modalities.\n\n\nRESULTS\nA total of 20 studies were included in this meta-analysis. Pooling 13 studies on overall survival (OS), we observed that presence of EC-LNI was associated with significantly worse OS (HR\xa0=\xa02.09, 95%CI: 1.63-2.68; p\xa0<\xa00.01). Nine studies describing disease-free survival (DFS) included, the pooled data revealed that presence of EC-LNI was associated with significantly worse DFS (HR\xa0=\xa01.89, 95%CI: 1.63-2.20; p\xa0<\xa00.001). Subset analyses of patients receiving neoadjuvant therapy demonstrated a survival disadvantage of EC-LNI on OS (HR\xa0=\xa01.928, 95%CI: 1.196-3.107; p\xa0=\xa00.007) and DFS (HR\xa0=\xa01.985, 95%CI: 1.585-2.487; p\xa0<\xa00.001). Similar result was also seen in patients receiving primary surgery (OS: HR\xa0=\xa02.219, 95%CI: 1.720-2.864; p\xa0<\xa00.001; DFS: HR\xa0=\xa01.659, 95%CI: 1.285-2.141; p\xa0<\xa00.001).\n\n\nCONCLUSION\nEC-LNI is a strong prognostic predictor of inferior survival in patients with esophageal cancer irrespective of treatment modality. The currently pooled evidence indicates that EC-LNI has great potential to be incorporated into the future staging system.