Montagnani Francesco, Fornaro Lorenzo, Frumento Paolo, Vivaldi Caterina, Falcone Alfredo, Fioretto Luisa
SC Oncologia Medica 1, Dipartimento Oncologico, Azienda USL Toscana Centro, Istituto Toscano Tumori, Piazza Santa Maria Nuova 1, 50100, Firenze, Italy.
Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Via Roma 67, 56126, Pisa, Italy.
Crit Rev Oncol Hematol. 2017 Jun;114:24-32. doi: 10.1016/j.critrevonc.2017.03.024. Epub 2017 Mar 23.
Surgery is the mainstay of treatment for oesophageal squamous-cell carcinoma (OSCC) but with poor results. Attempts to improve patient outcome have been made by introducing chemotherapy (CT), radiotherapy (RT), or both (CRT). However, randomized comparisons for all these strategies are not always available.
We conducted an extensive literature search for studies comparing surgery with multimodality treatment (i.e. [neo-]adjuvant CT or RT or CRT or definitive CRT). Network meta-analysis was performed in a Bayesian framewor and node-split models were built to assess inconsistency.
Twenty-five trials including a total of 3866 OSCC patients were included. Neoadjuvant CRT was associated with the most robust survival advantage across different multimodality treatment options (HR 0.73; 95% credible interval [CrI] 0.63-0.86). Definitive CRT was also significantly more effective than surgery but with greater uncertainties (HR 0.62; 95%CrI 0.41-0.96). Neoadjuvant CT (HR 0.90; 95%CrI 0.76-1.07) and adjuvant CRT (HR 1.00; 95%CrI 0.70-1.40) are associated with a non-significant benefit.
To date, neoadjuvant CRT seems to represent the best approach to maximize the benefit of a multimodality approach.
手术是食管鳞状细胞癌（OSCC）的主要治疗手段，但效果不佳。人们尝试通过引入化疗（CT）、放疗（RT）或两者联合（CRT）来改善患者预后。然而，并非总能获得所有这些策略的随机对照比较。
我们广泛检索文献，查找比较手术与多模式治疗（即新辅助CT或RT或CRT或根治性CRT）的研究。在贝叶斯框架下进行网络荟萃分析，并构建节点拆分模型以评估异质性。
纳入了25项试验，共3866例OSCC患者。在不同的多模式治疗方案中，新辅助CRT具有最强的生存优势（风险比[HR]0.73；95%可信区间[CrI]0.63 - 0.86）。根治性CRT也显著比手术更有效，但不确定性更大（HR 0.62；95%CrI 0.41 - 0.96）。新辅助CT（HR 0.90；95%CrI 0.76 - 1.07）和辅助CRT（HR 1.00；95%CrI 0.70 - 1.40）的获益无统计学意义。
迄今为止，新辅助CRT似乎是使多模式治疗获益最大化的最佳方法。
