Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12857/124575
Title: Extranodal extension of lymph node metastasis is a marker of poor prognosis in oesophageal cancer: a systematic review with meta-analysis
Authors: Luchini, Claudio 
Wood, Laura D
Cheng, Liang
Nottegar, Alessia 
Stubbs, Brendon
Solmi, Marco 
Capelli, Paola 
Pea, Antonio 
Sergi, Giuseppe 
Manzato, Enzo 
Fassan, Matteo 
Bagante, Fabio
Bollschweiler, Elfriede
Giacopuzzi, Simone 
Kaneko, Takuma
De Manzoni, Giovanni 
Barbareschi, Mattia
Scarpa, Aldo 
Veronese, Nicola 
Keywords: CANCER;METASTASIS;OESOPHAGUS
Keywords Plus: INVOLVEMENT;ADENOCARCINOMA;CARCINOMA;IMPACT;MANAGEMENT;BIAS
Issue Date: 7-Jul-2016
Publisher: BMJ PUBLISHING GROUP
Journal: Journal of clinical pathology 
Abstract: 
The extranodal extension (ENE) of nodal metastasis is the extension of neoplastic cells through the nodal capsule into the perinodal adipose tissue. This histological feature has recently been indicated as an important prognostic factor in different types of malignancies; in this manuscript, we aim at defining its role in the prognosis of oesophageal cancer with the tool of meta-analysis. Two independent authors searched SCOPUS and PubMed until 31 August 2015 without language restrictions. The studies with available data about prognostic parameters in subjects with oesophageal cancer, comparing patients with the presence of ENE (ENE+) versus only intranodal extension (ENE-), were considered as eligible. Data were summarised using risk ratios (RRs) for number of deaths/recurrences and HRs together with 95% CIs for time-dependent risk related to ENE+, adjusted for potential confounders. Fourteen studies were selected; they followed-up 1437 patients with oesophageal cancer for a median follow-up of 39.4 months. The presence of ENE was associated with a significantly increased risk of all-cause mortality (RR=1.33; 95% CI 1.18 to 1.50, p<0.0001, I2=49%; HR=2.72, 95% CI 2.03 to 3.64, p<0.0001, I2=0%), cancer-specific mortality (RR=1.35; 95% CI 1.14 to 1.59, p=0.001, I2=57%; HR=1.97, 95% CI 1.41 to 2.75, p<0.0001, I2=41%) and of risk of recurrence (RR=1.50, 95% CI 1.20 to 1.88, p<0.0001, I2=9%; HR=2.27, 95% CI 1.72 to 2.90, p<0.0001, I2=0%). On the basis of these results, in oesophageal cancer, ENE should be considered from the gross sampling to the pathology report, and in future oncological staging system.
URI: http://hdl.handle.net/20.500.12857/124575
ISSN: 00219746
DOI: 10.1136/jclinpath-2016-203830
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