Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2294-2304
Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2294
Prediction of lymph node metastasis in early esophageal cancer
Yan Li, Jun-Xiong Wang, Ran-Hen Yibi
Yan Li, Ran-Hen Yibi, Department of Gastroenterology, Lhasa People’s Hospital, Lhasa 850000, Tibet Autonomous Region, China
Jun-Xiong Wang, Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100000, China
Jun-Xiong Wang, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100000, China
Author contributions: YiBi RH conceived this study; Li Y drafted the article; Wang JX provided critical revision of this article; All authors approved the final version.
Supported by Natural Science Foundation of Tibetan Autonomous Region, No. XZ202101ZR0015G; Medical Program of Group Aid to Tibet, Natural Science Foundation of Tibetan Autonomous Region, No. XZ2021ZR-ZY27(Z).
Conflict-of-interest statement: All the authors declare that they have no competing interests.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ran-Hen Yibi, MBBS, Doctor, Department of Gastroenterology, Lhasa Peolpe’s Hospital, No. 1 Beijing Zhong Road, Chengguan District, Lhasa 850000, Tibet Autonomous Region, China. 18143216011@163.com
Received: June 12, 2023
Peer-review started: June 12, 2023
First decision: August 10, 2023
Revised: August 17, 2023
Accepted: September 4, 2023
Article in press: September 4, 2023
Published online: October 27, 2023
Processing time: 136 Days and 20.2 Hours
Abstract
BACKGROUND

Given the poor prognosis of patients with lymph node metastasis, estimating the lymph node status in patients with early esophageal cancer is crucial. Indicators that could be used to predict lymph node metastasis in early esophageal cancer have been reported in many recent studies, but no recent studies have included a review of this subject.

AIM

To review indicators predicting lymph node metastasis in early esophageal squamous cell carcinoma (ESCC) and early esophageal adenocarcinoma (EAC).

METHODS

We searched PubMed with “[early esophageal cancer (Title/Abstract)] and [lymph node (Title/Abstract)]” or “[early esophageal carcinoma (Title/Abstract)] and [lymph node (Title/Abstract)]” or “[superficial esophageal cancer (Title/Abstract)] and [lymph node (Title/Abstract)].” A total of 29 studies were eligible for analysis.

RESULTS

Preoperative imaging (size), serum markers (microRNA-218), postoperative pathology and immunohistochemical analysis (depth of invasion, tumor size, differentiation grade, lymphovascular invasion, neural invasion, expression of PIM-1 < 30%) were predictive factors for lymph node metastasis in both early ESCC and EAC. Serum markers (thymidine kinase 1 ≥ 3.38 pmol/L; cytokeratin 19 fragment antigen 21-1 > 3.30 ng/mL; stathmin-1) and postoperative pathology and immunohistochemical analysis (overexpression of cortactin, mixed-lineage leukaemia 2, and stanniocalcin-1) were predictive for lymph node metastasis in early ESCC. Transcription of CD69, myeloid differentiation protein 88 and toll-like receptor 4 and low expression of olfactomedin 4 were predictive of lymph node metastasis in early EAC. A total of 6 comprehensive models for early ESCC, including logistic regression model, nomogram, and artificial neural network (ANN), were reviewed. The areas under the receiver operating characteristic curve of these models reached 0.789-0.938, and the ANN performed best. As all these models relied on postoperative pathology, further models focusing on serum markers, imaging and immunohistochemical indicators are still needed.

CONCLUSION

Various factors were predictive of lymph node metastasis in early esophageal cancer, and present comprehensive models predicting lymph node metastasis in early ESCC mainly relied on postoperative pathology. Further studies focusing on serum markers, imaging and immunohistochemical indicators are still in need.

Keywords: Early esophageal cancer; Esophageal squamous cell carcinoma; Esophageal adenocarcinoma; Lymph node metastasis; Systematic review

Core Tip: In this study, we reviewed factors predicting lymph node metastasis in early esophageal squamous cell carcinoma (ESCC) and early esophageal adenocarcinoma (EAC). Imaging (size), serum microRNA-218, postoperative pathology and immunohistochemical analysis (depth, size, differentiation grade, lymphovascular invasion, neural invasion, PIM-1) were predictive for both ESCC and EAC. Serum markers (thymidine kinase 1; cytokeratin 19 fragment antigen 21-1; stathmin-1) and overexpression of cortactin, mixed-lineage leukaemia 2, and stanniocalcin-1 were predictive for ESCC. Transcription of CD69, myeloid differentiation protein 88 and toll-like receptor 4 and low expression of olfactomedin 4 were predictive for EAC. Six comprehensive models for ESCC were reviewed, and the areas under the curve reached 0.789-0.938.