Kamarajah Sivesh K, Marson Ella J, Zhou Dengyi, Wyn-Griffiths Freddie, Lin Aaron, Evans Richard P T, Bundred James R, Singh Pritam, Griffiths Ewen A
Northern Oesophagogastric Cancer Unit, Newcastle University NHS Foundation Trust Hospitals, Newcastle upon Tyne, UK.
Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK.
Dis Esophagus. 2020 Nov 18;33(11). doi: 10.1093/dote/doaa038.
Currently, the American Joint Commission on Cancer (AJCC) staging system is used for prognostication for oesophageal cancer. However, several prognostically important factors have been reported but not incorporated. This meta-analysis aimed to characterize the impact of preoperative, operative, and oncological factors on the prognosis of patients undergoing curative resection for oesophageal cancer.
This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling to determine pooled univariable hazard ratios (HRs). The study was prospectively registered with the PROSPERO database (Registration: CRD42018157966).
One-hundred and seventy-one articles including 73,629 patients were assessed quantitatively. Of the 122 factors associated with survival, 39 were significant on pooled analysis. Of these. the strongly associated prognostic factors were 'pathological' T stage (HR: 2.07, CI95%: 1.77-2.43, P < 0.001), 'pathological' N stage (HR: 2.24, CI95%: 1.95-2.59, P < 0.001), perineural invasion (HR: 1.54, CI95%: 1.36-1.74, P < 0.001), circumferential resection margin (HR: 2.17, CI95%: 1.82-2.59, P < 0.001), poor tumor grade (HR: 1.53, CI95%: 1.34-1.74, P < 0.001), and high neutrophil:lymphocyte ratio (HR: 1.47, CI95%: 1.30-1.66, P < 0.001).
Several tumor biological variables not included in the AJCC 8th edition classification can impact on overall survival. Incorporation and validation of these factors into prognostic models and next edition of the AJCC system will enable personalized approach to prognostication and treatment.
目前，美国癌症联合委员会（AJCC）分期系统用于食管癌的预后评估。然而，已有多项具有重要预后意义的因素被报道，但尚未纳入该系统。本荟萃分析旨在明确术前、手术及肿瘤学因素对接受食管癌根治性切除术患者预后的影响。
本系统评价按照PRISMA指南进行，通过检索截至2018年12月31日的PubMed、Scopus和Cochrane CENTRAL数据库确定符合条件的研究。采用随机效应模型进行荟萃分析，以确定合并的单变量风险比（HRs）。该研究已在PROSPERO数据库前瞻性注册（注册号：CRD42018157966）。
对171篇文章（共73629例患者）进行了定量评估。在与生存相关的122个因素中，39个在合并分析中有显著意义。其中，与预后密切相关的因素包括“病理”T分期（HR：2.07，95%CI：1.77 - 2.43，P < 0.001）、“病理”N分期（HR：2.24，95%CI：1.95 - 2.59，P < 0.001）、神经周围侵犯（HR：1.54，95%CI：1.36 - 1.74，P < 0.001）、环周切缘（HR：2.17，95%CI：1.82 - 2.59，P < 0.001）、肿瘤低分化（HR：1.53，95%CI：1.34 - 1.74，P < 0.001）以及高中性粒细胞与淋巴细胞比值（HR：1.47，95%CI：1.30 - 1.66，P < 0.001）。
AJCC第8版分类未纳入的几个肿瘤生物学变量可影响总生存期。将这些因素纳入并验证到预后模型以及AJCC系统的下一版中，将有助于实现个性化的预后评估和治疗方法。
