[Neoadjuvant chemoradiotherapy combined with operation vs. operation alone for resectable esophageal cancer: Meta-analysis on randomized controlled trials].

OBJECTIVE

To compare the treatment outcomes of neoadjuvant chemoradiotherapy (NCRT) combined with operation and operation alone for esophageal cancer.

METHODS

Randomized controlled trials(RCTs), comparing the treatment outcomes of NCRT combined with operation to operation alone for esophageal cancer, published from January 1990 to December 2015 were searched from PubMed, Web of Science, and other English-language databases. STATA 10.0 software was used to analyze short-term efficacy (R0 resection rate, positive lymph node ratio, postoperative complications and mortality) and long-term outcomes (overall survival rate and local recurrence rate). The publication bias was evaluated by funnel plot and Egger test.

RESULTS

A total of 12 RCTs, including 1 872 esophageal cancer patients, were included in the meta-analysis, with 939 cases in NCRT combined with operation group and 943 cases in operation alone group. Meta-analysis of short-term efficacy showed that, as compared to operation alone group, NCRT combined with operation group had higher R0 resection rate (RR=1.19, 95%CI:1.08 to 1.32, P=0.015), lower positive lymph node rate (RR=0.55, 95%CI:0.49 to 0.63, P=0.001), but higher postoperative mortality (RR=1.63, 95%CI:1.09 to 2.45, P=0.018). Postoperative complications were similar between the two groups(RR=1.04, 95%CI:0.91 to 1.18, P=0.558). Meta-analysis of long-term outcomes showed that, as compared to operation alone group, NCRT combined with operation group had lower local recurrence rate (RR=0.50, 95%CI:0.39 to 0.64, P=0.000), and higher overall survival rate (HR=0.75, 95%CI:0.66 to 0.84, P=0.001). Subgroup analysis according to pathological types showed that both squamous cell carcinoma and adenocarcinoma patients in NCRT combined with operation group had higher overall survival rates compared to those in operation alone group (HR=0.80, 95%CI:0.69 to 0.93, P=0.003; HR=0.78, 95%CI:0.70 to 0.88, P=0.003).

CONCLUSIONS

NCRT can decrease the staging of esophageal cancer, elevate the R0 resection rate, and ameliorate local recurrence without increasing postoperative complications. Meanwhile NCRT can improve overall survival of esophageal cancer patients even with squamous cell carcinoma and adenocarcinoma.