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

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

JOURNAL=Frontiers in Oncology

VOLUME=12

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1025855

DOI=10.3389/fonc.2022.1025855

ISSN=2234-943X

ABSTRACT=<sec><title>Objective</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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; <italic>P &lt;</italic> 0.001; <italic>I<sup>2</sup></italic> = 0.0%, <italic>P</italic> = 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; <italic>P &lt;</italic> 0.001; <italic>I<sup>2</sup></italic> = 50.18%, <italic>P</italic> = 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.</p></sec><sec><title>Conclusion</title><p>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.</p></sec><sec><title>Systematic review registration</title><p><uri xlink:href="https://www.crd.york.ac.uk/prospero" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero</uri>, identifier (CRD42022321768).</p></sec>