Abstract
Oesophageal cancer is the sixth commonest cause of overall cancer mortality. Clinical staging utilizes multiple imaging modalities to guide treatment and prognostication. T2N0 oesophageal cancer is a treatment threshold for neoadjuvant therapy. Data on accuracy of current clinical staging tests for this disease subgroup are conflicting. We performed a meta-analysis of all primary studies comparing clinical staging accuracy using multiple imaging modalities (index test) to histopathological staging following oesophagectomy (reference standard) in T2N0 oesophageal cancer. Patients that underwent neoadjuvant therapy were excluded. Electronic databases (MEDLINE, Embase, Cochrane Library) were searched up to September 2019. The primary outcome was diagnostic accuracy of combined T&N clinical staging. Publication date, first recruitment date, number of centers, sample size and geographical location main histological subtype were evaluated as potential sources of heterogeneity. The search strategy identified 1,199 studies. Twenty studies containing 5,213 patients met the inclusion criteria. Combined T&N staging accuracy was 19% (95% CI, 15-24); T staging accuracy was 29% (95% CI, 24-35); percentage of patients with T downstaging was 41% (95% CI, 33-50); percentage of patients with T upstaging was 28% (95% CI, 24-32) and percentage of patients with N upstaging was 34% (95% CI, 30-39). Significant sources of heterogeneity included the number of centers, sample size and study region. T2N0 oesophageal cancer staging remains inaccurate. A significant proportion of patients were downstaged (could have received endotherapy) or upstaged (should have received neoadjuvant chemotherapy). These findings were largely unchanged over the past two decades highlighting an urgent need for more accurate staging tests for this subgroup of patients.
Highlights
Oesophageal cancer is the seventh most common cause of cancer worldwide and the sixth most common cause of overall cancer mortality.[1]
We only evaluated patients with cT2N0M0 and were unable to calculate sensitivity and specificity values as these require the number of false negatives for a given test
Principal findings To our knowledge, this is the first systematic review and meta-analysis evaluating the accuracy of current clinical staging tests of T2 oesophageal cancer
Summary
Oesophageal cancer is the seventh most common cause of cancer worldwide and the sixth most common cause of overall cancer mortality.[1]. A number of recent studies assessing oesophageal cancer therapy have shown differing results, especially with regards to the benefits of neoadjuvant chemotherapy and radiotherapy. One prospective randomized trial suggested that neoadjuvant chemoradiotherapy reduced mortality and increased disease-free survival in patients with locally advanced oesophageal cancer (T1N1M0 or T2–3 N0–1 M0).[6] in patients with T2N0 disease, the benefit is less clear, with a recent European multicenter retrospective study demonstrating that neoadjuvant therapy had no impact on recurrence, disease-free survival and overall survival.[7] A major limitation of those studies has been the variable accuracy of clinical staging for T2N0 disease reported in the literature.
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Schedule a callMore From: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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