Abstract
BackgroundIn clinical studies, it has been observed that esophageal cancer (EC) patient prognosis can be very different even for those patients with tumors of the same TNM stage. Tumor length has been analysed as a possible independent prognostic factor in many studies, but no unanimous conclusion has been reached. Therefore, this review used a meta-analysis to evaluate the association between tumor length and prognosis in EC patients.MethodsA systematic search for relevant articles was performed in PubMed, Web of Science, and Embase. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used as effective measures to estimate the correlation between tumor length and prognosis, including overall survival, disease-free survival, progression-free survival, disease-specific survival, and cancer-specific survival. STATA 15.0 software was used to perform the meta-analysis and the data synthesis.ResultsFinally, 41 articles with 28,973 patients were included in our study. The comprehensive statistical results showed that long tumors are an independent prognostic parameter associated with poor overall survival (OS) (HR = 1.30; 95% CI: 1.21–1.40, p < .001) and disease-free survival (DFS) (HR = 1.38; 95% CI: 1.18–1.61, p < .001) in EC patients. Subgroup analyses also suggested a significant correlation between long tumors and poor OS. Sensitivity analysis and publication bias evaluation confirmed the reliability and stability of the results. Similar results were obtained in the analyses of progression-free survival (PFS), disease-specific survival (DSS), and cancer-specific survival (CSS).ConclusionThe results of this meta-analysis showed that long tumors were related to poor OS, DFS, PFS, DSS and CSS in EC patients. Tumor length might be an important predictor of prognosis in EC patients, and it can be used as an independent staging index. Further well-designed and large-scale prospective clinical studies are needed to confirm these findings.
Highlights
In clinical studies, it has been observed that esophageal cancer (EC) patient prognosis can be very different even for those patients with tumors of the same TNM stage
The characteristics of the included studies Based on the search strategy mentioned above, a total of 1110 articles were searched from PubMed, Embase and Web of Science
23 studies were from China [7, 9, 10, 30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49], 7 studies were from the USA [6, 50,51,52,53,54,55], 7 studies were from Japan [8, 24,25,26,27,28,29], and 1 study each was from Italy [22], Australia [20], the Netherlands [21], and Turkey [23]; the participants in 39 studies were patients with Squamous cell carcinoma (SCC)
Summary
It has been observed that esophageal cancer (EC) patient prognosis can be very different even for those patients with tumors of the same TNM stage. Tumor length has been analysed as a possible independent prognostic factor in many studies, but no unanimous conclusion has been reached. This review used a meta-analysis to evaluate the association between tumor length and prognosis in EC patients. Most patients die within 1 year of diagnosis [1]. There are established radiotherapy and chemotherapy regimens, surgical resection is still the only possible cure for this disease. Complete surgical resection and radical lymph node dissection can provide accurate pTNM staging, which has important guiding significance for predicting prognosis and determining treatment options after surgery. An effective and reasonable EC staging system is important for the selection of treatment options and the prediction of long-term survival [4]
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