Pasquali Sandro, Yim Guang, Vohra Ravinder S, Mocellin Simone, Nyanhongo Donald, Marriott Paul, Geh Ju Ian, Griffiths Ewen A
*Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy †Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ‡Nottingham Oesophago-Gastric Unit, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK §Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy ¶The Cancer Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Ann Surg. 2017 Mar;265(3):481-491. doi: 10.1097/SLA.0000000000001905.
This network meta-analysis compared overall survival after neoadjuvant or adjuvant chemotherapy (CT), radiotherapy (RT), or combinations of both (chemoradiotherapy, CRT) or surgery alone to identify the most effective approach.
The optimal treatment for resectable esophageal cancer is unknown.
A search for randomized controlled trials reporting on neoadjuvant and adjuvant therapies was conducted. Using a network meta-analysis, treatments were ranked based on their effectiveness for improving survival.
In 33 eligible randomized controlled trials, 6072 patients were randomized to receive either surgery alone (N = 2459) or neoadjuvant CT (N = 1332), RT (N = 58), and CRT (N = 1196) followed by surgery or surgery followed by adjuvant CT (N = 542), RT (N = 383), and CRT (N = 102). Twenty-one comparisons were generated. Neoadjuvant CRT followed by surgery compared with surgery alone was the only treatment to significantly improve survival [hazard ratio (HR) = 0.77, 95% confidence interval (CI): 0.68-0.87]. When trials were grouped considering neoadjuvant and adjuvant therapies and surgery alone, neoadjuvant therapies combined with surgery compared with surgery alone showed a survival advantage (HR = 0.83, 95% CI 0.76-0.90), whereas surgery along with adjuvant therapies showed no significant survival advantage (HR = 0.87, 95% CI 0.67-1.14). A subgroup analysis of neoadjuvant therapies showed a superior effectiveness of neoadjuvant CRT and surgery compared with surgery alone (HR = 0.77, 95% CI 0.68-0.87).
This network meta-analysis showed neoadjuvant CRT followed by surgery to be the most effective strategy in improving survival of resectable esophageal cancer. Resources should be focused on developing the most effective neoadjuvant CRT regimens for both adenocarcinomas and squamous cell carcinomas of the esophagus.
本网状Meta分析比较了新辅助或辅助化疗（CT）、放疗（RT）或两者联合（放化疗，CRT）或单纯手术治疗后的总生存期，以确定最有效的治疗方法。
可切除食管癌的最佳治疗方法尚不清楚。
检索报道新辅助和辅助治疗的随机对照试验。采用网状Meta分析，根据治疗对提高生存率的有效性进行排序。
在33项符合条件的随机对照试验中，6072例患者被随机分配接受单纯手术（N = 2459）或新辅助CT（N = 1332）、RT（N = 58）和CRT（N = 1196），随后进行手术，或手术加辅助CT（N = 542）、RT（N = 383）和CRT（N = 102）。共产生了21项比较。新辅助CRT后手术与单纯手术相比是唯一显著提高生存率的治疗方法[风险比（HR）= 0.77，95%置信区间（CI）：0.68 - 0.87]。当根据新辅助和辅助治疗以及单纯手术对试验进行分组时，新辅助治疗联合手术与单纯手术相比显示出生存优势（HR = 0.83，95% CI 0.76 - 0.90），而手术加辅助治疗未显示出显著的生存优势（HR = 0.87，95% CI 0.67 - 1.14）。新辅助治疗的亚组分析显示，新辅助CRT和手术与单纯手术相比具有更高的有效性（HR = 0.77，95% CI 0.68 - 0.87）。
本网状Meta分析表明，新辅助CRT后手术是提高可切除食管癌生存率的最有效策略。资源应集中于为食管腺癌和鳞状细胞癌开发最有效的新辅助CRT方案。
