Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Br J Surg. 2011 Jun;98(6):768-83. doi: 10.1002/bjs.7455. Epub 2011 Apr 4.
The standard treatment for resectable oesophageal squamous cell carcinoma (OSCC) is surgical resection with adequate lymphadenectomy. Most Western patients receive neoadjuvant chemotherapy or chemoradiotherapy (CRT). In recent years some patients have received CRT alone (definitive CRT, dCRT). This meta-analysis sought to clarify the benefits of neoadjuvant and definitive treatment for OSCC.
Eligible randomized controlled trials (RCTs) were identified using the Cochrane database, MEDLINE and Embase. Only RCTs with intention-to-treat analysis, and published hazard ratios (HRs) or estimates from survival data, were included.
Nine RCTs involving neoadjuvant CRT versus surgery, eight involving neoadjuvant chemotherapy versus surgery, and three involving neoadjuvant treatment followed by surgery or surgery alone versus dCRT were identified. The HR for overall survival was 0·81 (95 per cent confidence interval 0·70 to 0·95; P = 0·008) after neoadjuvant CRT and 0·93 (0·81 to 1·08; P = 0·368) after neoadjuvant chemotherapy. The likelihood of R0 resection was significantly higher after neoadjuvant treatment (CRT: HR 1·15, P = 0·043; chemotherapy: HR 1·16, P = 0·006). Morbidity rates were not increased after neoadjuvant CRT (HR 0·94, P = 0·363) but 30-day mortality was non-significantly higher with combined treatment. Morbidity (HR 1·03, P = 0·638) and mortality (HR 1·04, P = 0·810) rates after neoadjuvant chemotherapy and surgery did not differ from those after surgery alone. None of the RCTs reporting outcome after dCRT demonstrated a significant survival benefit, but treatment-related mortality rates were lower (HR 7·60, P = 0·007) than with neoadjuvant treatment followed by surgery or surgery alone.
For patients with resectable OSCC, a significant survival benefit for neoadjuvant CRT was evident, with no increase in morbidity rate. dCRT did not demonstrate any survival benefit over other curative strategies. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
可切除食管鳞癌（OSCC）的标准治疗方法是手术切除加充分的淋巴结清扫术。大多数西方患者接受新辅助化疗或放化疗（CRT）。近年来，一些患者单独接受 CRT（根治性 CRT，dCRT）。本荟萃分析旨在阐明新辅助和根治性治疗 OSCC 的益处。
使用 Cochrane 数据库、MEDLINE 和 Embase 确定合格的随机对照试验（RCT）。仅纳入具有意向治疗分析的 RCT，以及发表的生存数据危险比（HR）或估计值。
共纳入 9 项新辅助 CRT 与手术比较的 RCT、8 项新辅助化疗与手术比较的 RCT 和 3 项新辅助治疗后手术或单纯手术与 dCRT 比较的 RCT。新辅助 CRT 后总生存率的 HR 为 0.81（95%置信区间 0.70 至 0.95；P=0.008），新辅助化疗后为 0.93（0.81 至 1.08；P=0.368）。新辅助治疗后 R0 切除的可能性显著增加（CRT：HR 1.15，P=0.043；化疗：HR 1.16，P=0.006）。新辅助 CRT 并未增加发病率（HR 0.94，P=0.363），但联合治疗的 30 天死亡率显著升高。新辅助化疗和手术的发病率（HR 1.03，P=0.638）和死亡率（HR 1.04，P=0.810）与单纯手术无差异。报告 dCRT 后结局的 RCT 均未显示出生存获益的显著差异，但治疗相关死亡率较低（HR 7.60，P=0.007）。
对于可切除的 OSCC 患者，新辅助 CRT 可显著提高生存率，且发病率无增加。dCRT 并未显示出优于其他根治性策略的生存获益。
