title: Prognostic significance of positive circumferential resection margin in esophageal cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  To assess the prognostic significance of positive circumferential resection margin on overall survival in patients with esophageal cancer, a systematic review and meta-analysis was performed.
  
  
  METHODS
  Studies were identified from PubMed, EMBASE, and Web of Science. Survival data were extracted from eligible studies to compare overall survival in patients with a positive circumferential resection margin with patients having a negative circumferential resection margin according to the Royal College of Pathologists (RCP) criteria and the College of American Pathologists (CAP) criteria. Survival data were pooled with hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). A random-effects model meta-analysis on overall survival was performed.
  
  
  RESULTS
  The pooled HRs for survival were 1.510 (95% CI, 1.329-1.717; p<0.001) and 2.053 (95% CI, 1.597-2.638; p<0.001) according to the RCP and CAP criteria, respectively. Positive circumferential resection margin was associated with worse survival in patients with T3 stage disease according to the RCP (HR, 1.381; 95% CI, 1.028-1.584; p=0.001) and CAP (HR, 2.457; 95% CI, 1.902-3.175; p<0.001) criteria, respectively. Positive circumferential resection margin was associated with worse survival in patients receiving neoadjuvant therapy according to the RCP (HR, 1.676; 95% CI, 1.023-2.744; p=0.040) and CAP (HR, 1.847; 95% CI, 1.226-2.78; p=0.003) criteria, respectively.
  
  
  CONCLUSIONS
  Positive circumferential resection margin is associated with poor prognosis in patients with esophageal cancer, particularly in patients with T3 stage disease and patients receiving neoadjuvant therapy.
authors.affiliation: Department of Surgical Oncology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Qi-Xun
authors.initials: QX
authors.lastname: Chen
authors.affiliation: Department of Surgical Oncology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: lsteng@zju.edu.cn.
authors.forename: Li-song
authors.initials: LS
authors.lastname: Teng
authors.affiliation: Meridian Cancer Care, Jersey Shore University Medical Center, Neptune, New Jersey.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Krasna
mesh_terms: D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D011379:Prognosis
keywords: 7