INTRODUCTION Currently, the American Joint Commission on Cancer (AJCC) staging system is used for prognostication for oesophageal cancer. However, several prognostically important factors have been reported but not incorporated. This meta-analysis aimed to characterize the impact of preoperative, operative, and oncological factors on the prognosis of patients undergoing curative resection for oesophageal cancer. METHODS This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling to determine pooled univariable hazard ratios (HRs). The study was prospectively registered with the PROSPERO database (Registration: CRD42018157966). RESULTS One-hundred and seventy-one articles including 73,629 patients were assessed quantitatively. Of the 122 factors associated with survival, 39 were significant on pooled analysis. Of these. the strongly associated prognostic factors were 'pathological' T stage (HR: 2.07, CI95%: 1.77-2.43, P < 0.001), 'pathological' N stage (HR: 2.24, CI95%: 1.95-2.59, P < 0.001), perineural invasion (HR: 1.54, CI95%: 1.36-1.74, P < 0.001), circumferential resection margin (HR: 2.17, CI95%: 1.82-2.59, P < 0.001), poor tumor grade (HR: 1.53, CI95%: 1.34-1.74, P < 0.001), and high neutrophil:lymphocyte ratio (HR: 1.47, CI95%: 1.30-1.66, P < 0.001). CONCLUSION Several tumor biological variables not included in the AJCC 8th edition classification can impact on overall survival. Incorporation and validation of these factors into prognostic models and next edition of the AJCC system will enable personalized approach to prognostication and treatment.

中文翻译：

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食管癌行食管切除术患者总体生存预后因素的荟萃分析。

引言目前，美国癌症联合委员会（AJCC）分期系统用于食道癌的预后。然而，已经报道了几个对预后重要的因素，但并未纳入。这项荟萃分析旨在表征术前，术中和肿瘤学因素对食管癌根治性切除术患者预后的影响。方法这项系统性回顾是根据PRISMA指南进行的，通过检索截至2018年12月31日的PubMed，Scopus和Cochrane CENTRAL数据库确定了合格的研究。使用随机效应模型进行荟萃分析，确定合并的单变量风险比（HRs）。该研究已在PROSPERO数据库中进行了前瞻性注册（注册：CRD42018157966）。结果对包括73629例患者的171篇文章进行了定量评估。在与生存相关的122个因素中，有39个在汇总分析中具有重要意义。这些。与病程密切相关的预后因素是“病理性” T期（HR：2.07，CI95％：1.77-2.43，P <0.001），“病理性” N期（HR：2.24，CI95％：1.95-2.59，P <0.001），神经周围浸润（HR：1.54，CI95％：1.36-1.74，P <0.001），环周切缘（HR：2.17，CI95％：1.82-2.59，P <0.001），肿瘤分级差（HR：1.53，CI95％： 1.34-1.74，P <0.001）和高嗜中性粒细胞：淋巴细胞比率（HR：1.47，CI95％：1.30-1.66，P <0.001）。结论AJCC第8版分类中未包括的一些肿瘤生物学变量会影响整体生存率。