Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma： A meta-analysis

• Published in: World journal of gastroenterology : WJG Vol. 15; no. 47; pp. 5983 - 5991
• Main Authors: Jin, Hai-Lin, Zhu, Hong, Ling, Ting-Sheng, Zhang, Hong-Jie, Shi, Rui-Hua
• Format: Journal Article
• Language: English
• Published: United States Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China 21.12.2009; The WJG Press and Baishideng
• Subjects: Adenocarcinoma - therapy; Brief; Chemotherapy, Adjuvant; Databases, Factual; Esophageal Neoplasms - mortality; Esophageal Neoplasms - therapy; Humans; MEDLINE; Neoadjuvant Therapy; Odds Ratio; Radiotherapy, Adjuvant; Randomized Controlled Trials as Topic; Recurrence; Survival Rate; 可信区间; 手术切除; 生存率; 随机对照试验; 食管癌; 鳞状细胞癌; Esophageal carcinoma; Randomized controlled trial; Neoadjuvant chemoradiotherapy; Meta-analysis; Metaanalysis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.15.5983

AIM：To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma. METHODS：We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed.Trial validity assessment was performed and a trial quality score was assigned. RESULTS：Eleven randomized controlled trials（RCTs） including 1308 patients were selected.Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone.Odds ratio（OR） [95%confidence interval（CI）,P value],expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone,was 1.28（1.01-1.64,P=0.05）for 1-year survival,1.78（1.20-2.66,P=0.004）for 3-year survival,and 1.46（1.07-1.99,P=0.02）for 5-year survival.Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy（OR： 1.68,95%CI：1.03-2.73,P=0.04）,but incidence of postoperative complications was similar in two groups （OR：1.14,95%CI：0.88-1.49,P=0.32）.Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence（OR：0.64,95%CI：0.41-0.99,P=0.04）, but incidence of distant cancer recurrence was similar （OR：0.94,95%CI：0.68-1.31,P=0.73）.Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvantchemoradiotherapy,OR（95%CI,P value）was 1.16（0.85-1.57,P=0.34）for 1-year survival,1.34 （0.98-1.82,P=0.07）for 3-year survival and 1.41 （0.98-2.02,P=0.06）for 5-year survival. CONCLUSION：Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.