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Meta-Analysis
. 2019 Jun 25;3(5):595-605.
doi: 10.1002/bjs5.50183. eCollection 2019 Oct.

Meta-analysis of the influence of a positive circumferential resection margin in oesophageal cancer

R Evans  1 , J R Bundred  1   2 , P Kaur  1 , J Hodson  3 , E A Griffiths  1   4
Affiliations
Meta-Analysis

Meta-analysis of the influence of a positive circumferential resection margin in oesophageal cancer

R Evans et al. BJS Open. .

Abstract

Background: The evidence regarding the prognostic impact of a positive circumferential resection margin (CRM) in oesophageal cancer is conflicting, and there is global variability in the definition of a positive CRM. The aim of this study was to determine the impact of a positive CRM on survival in patients undergoing oesophagectomy for oesophageal cancer.

Methods: A systematic review and meta-analysis was performed. PubMed and Embase databases were searched for articles to May 2018 examining the effect of a positive CRM on survival. Cohort studies written in English were included. Meta-analyses of univariable and multivariable hazard ratios (HRs) were performed using both Royal College of Pathologists (RCP) and College of American Pathologists (CAP) criteria. Risk of bias was assessed using the Newcastle-Ottawa Scale. Egger regression, and Duval and Tweedie trim-and-fill statistics were used to assess publication bias.

Results: Of 133 studies screened, 29 incorporating 6142 patients were finally included for analysis. Pooled univariable HRs for overall survival in patients with a positive CRM were 1·68 (95 per cent c.i. 1·48 to 1·91; P < 0·001) and 2·18 (1·84 to 2·60; P < 0·001) using RCP and CAP criteria respectively. Subgroup analyses demonstrated similar results for patients by T category, neoadjuvant therapy and tumour type. Pooled HRs from multivariable analyses suggested that a positive CRM was independently predictive of a worse overall survival (RCP: 1·41, 1·21 to 1·64, P < 0·001; CAP: 2·37, 1·60 to 3·51, P < 0·001).

Conclusion: A positive CRM is associated with a worse prognosis regardless of classification system, T category, tumour type or neoadjuvant therapy.

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Figures

Figure 1
Figure 1
PRISMA diagram for the review
Figure 2
Figure 2
Forest plot of all studies assessing the influence of a positive circumferential resection margin in accordance with the Royal College of Pathologists' definition An inverse‐variance random‐effects model was used for meta‐analysis. Hazard ratios (HRs) are shown with 95 per cent confidence intervals. CRM−/+, negative/positive circumferential resection margin; RCP, Royal College of Pathologists.
Figure 3
Figure 3
Forest plot of all studies assessing the influence of a positive circumferential resection margin in accordance with the College of American Pathologists' definition An inverse‐variance random‐effects model was used for meta‐analysis. Hazard ratios (HRs) are shown with 95 per cent confidence intervals. CRM−/+, negative/positive circumferential resection margin; CAP, College of American Pathologists.
Figure 4
Figure 4
Funnel plot of all studies assessing the influence of a positive circumferential resection margin in accordance with the Royal College of Pathologists' definition HR, hazard ratio.
Figure 5
Figure 5
Funnel plot of all studies assessing the influence of a positive circumferential resection margin in accordance with the College of American Pathologists' definition HR, hazard ratio.
Figure 6
Figure 6
Forest plot of all studies assessing, via multivariable analysis, the influence of a positive circumferential resection margin in accordance with the Royal College of Pathologists' definition An inverse‐variance random‐effects model was used for meta‐analysis. Hazard ratios (HRs) are shown with 95 per cent confidence intervals. CRM−/+, negative/positive circumferential resection margin; RCP, Royal College of Pathologists.
Figure 7
Figure 7
Forest plot of all studies assessing, via multivariable analysis, the influence of a positive circumferential resection margin in accordance with the College of American Pathologists' definition An inverse‐variance random‐effects model was used for meta‐analysis. Hazard ratios (HRs) are shown with 95 per cent confidence intervals. CRM−/+, negative/positive circumferential resection margin; CAP, College of American Pathologists.
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