Risk factors for lymph node metastasis in T1 esophageal squamous cell carcinoma: A systematic review and meta-analysis

doi:10.3748/wjg.v27.i8.737

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Feb 28, 2021 (publication date) through Feb 23, 2026

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World Journal of Gastroenterology

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Meta-Analysis

World J Gastroenterol. Feb 28, 2021; 27(8): 737-750
Published online Feb 28, 2021. doi: 10.3748/wjg.v27.i8.737

Risk factors for lymph node metastasis in T1 esophageal squamous cell carcinoma: A systematic review and meta-analysis

Kai-Yuan Jiang, Heng Huang, Wei-Yang Chen, Hao-Ji Yan, Zhen-Ting Wei, Xiao-Wen Wang, Hao-Xuan Li, Xiang-Yun Zheng, Dong Tian

Kai-Yuan Jiang, Heng Huang, Wei-Yang Chen, Hao-Ji Yan, Zhen-Ting Wei, Xiao-Wen Wang, Hao-Xuan Li, Xiang-Yun Zheng, College of Clinical Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China

Kai-Yuan Jiang, Dong Tian, Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China

Author contributions: Jiang KY, Huang H and Tian D designed the research; Jiang KY and Huang H performed the research and drafted the article; Chen WY, Yan HJ and Wei ZT screened the literature and collected the data; Wang XW, Li HX and Zheng XY analyzed the data and interpreted the data; Tian D revised the article; All authors have read and approved the final manuscript; Jiang KY and Huang H contributed equally to this work.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Dong Tian, MD, PhD, Doctor, Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, No. 63 Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China. 22tiandong@163.com

Received: November 28, 2020
Peer-review started: November 28, 2020
First decision: January 17, 2021
Revised: January 20, 2021
Accepted: February 1, 2021
Article in press: February 1, 2021
Published online: February 28, 2021
Processing time: 90 Days and 1.2 Hours

ARTICLE HIGHLIGHTS

Research background

Endoscopic resection has been increasingly used in patients with T1 esophageal squamous cell carcinoma (ESCC). However, lymph node metastasis (LNM) has been widely reported in patients with T1 ESCC, and some studies have even found higher rates of metastasis. Endoscopic resection for T1 ESCC should be carefully considered.

Research motivation

Endoscopic resection is not appropriate for patients with a potential risk of LNM and the risk of metastasis must be assessed in advance to make the right decision. In addition, reports of the risk factors for LNM have been controversial.

Research objectives

The purpose of this meta-analysis was to assess risk factors of LNM for patients with T1 ESCC.

Research methods

We conducted a comprehensive search of multiple electronic databases including PubMed, EMBASE and the Cochrane Library to select studies related to the topics. Statistical analysis was conducted via comprehensive meta-analysis software.

Research results

A total of 3775 patients with T1 ESCC from 17 studies were included. The rates of LNM in T1a and T1b were 5.4% and 33.7%, respectively. Tumor size > 2 cm, lower tumor location, nonflat macroscopic type, T1b stage, poor differentiation and lymphovascular invasion were found to be significantly associated with LNM. Conversely, sex, age and infiltrative growth pattern were not identified as risk factors for LNM.

Research conclusions

This meta-analysis is the first to comprehensively evaluate LNM only in ESCC patients with T1 stage. For patients with a potential high risk of LNM, radical esophagectomy is superior to endoscopic resection, and potential metastatic lymph nodes can be dissected.

Research perspectives

All included studies were performed in Asian countries (China, Japan and South Korea), and the results may therefore be influenced by ethnicity. There is still a need to include data from other continents.