Risk and Pathological Factors of Recurrence after Endoscopic Resection for Superficial Esophageal Squamous Cell Carcinoma: A Systematic Review and Meta-analysis.

ABSTRACT

BACKGROUND AND AIMS: The risk and pathological factors of recurrence after endoscopic resection (ER) for superficial esophageal squamous cell carcinoma (ESCC) are inconsistent across studies. We evaluated this in a systematic review and meta-analysis. METHODS: The data of recurrence in such patients was extracted from all studies. Risk ratios (RRs) were combined using random-effects meta-analysis, to assess pooled recurrence rate and pathological risk factors. Relapse-free survival was combined using the Kaplan-Meier method to estimate the relationship between various pathological factors and recurrence time. RESULTS: We identified 26 studies, with a total of 5100 patients and 321 with recurrences (pooled rate, 6.2%). The risk of recurrence was significantly higher in positive vertical margin (VM) (RR [95% CI] 4.51 [2.16 - 9.44]), positive horizontal margin (HM) (RR [95% CI] 2.54 [1.57 - 4.13]), lymphovascular invasion (LVI) (RR [95% CI] 2.33 [1.75 - 3.11], P < 0.001), lymphatic invasion (LI) (RR [95% CI] 2.24 [1.24 - 4.06]), and tumor invading submucosa ≤200 µm (SM1) (RR [95% CI] 1.71 [1.32 - 2.21], compared to muscularis mucosa). Patients with LI (HR 2.47; 95% CI 1.24 - 4.90; P = 0.02) and LVI (HR 2.36; 95% CI 2.22 - 4.59; P = 0.0006) tended to have earlier recurrence after ER. CONCLUSION: The recurrence rate of superficial ESCC after ER is acceptable. Patients with positive margins, LVI, LI and SM1 need to pay significant attention to the risk of recurrence. LI and VI should be evaluate separately. (PROSPERO CRD42023406309).