Tie H, He F, Shen J, Zhang B, Ye M, Chen B, Wu Q
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing.
Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China.
Dis Esophagus. 2018 Jan 1;31(1):1-9. doi: 10.1093/dote/dox116.
Whether a prolonged interval between neoadjuvant chemoradiotherapy (nCRT) and esophagectomy could benefits conditions such as rectal cancer, still remains unknown. We therefore performed the current study to evaluate the influence of the interval between nCRT and esophagectomy on the clinical outcomes in patients with esophageal cancer. PubMed and Embase were searched to identify eligible cohort studies. The primary outcome was five-year overall survival (OS), and secondary outcomes included the incidence of anastomotic complications, perioperative mortality, pathologic complete response (pCR) rate, positive circumferential resection margin (CRM) rate, and R0 resection rate. A random-effects model was used for all meta-analyses irrespective of heterogeneity. Ten cohort studies with 2383 patients were included. Overall, the pooled estimate revealed that the prolonged interval has no impact on five-year OS (odds ratio (OR) 0.87, 95% CI 0.66 to 1.14, P = 0.30), with low heterogeneity (PH = 0.78, I2 = 0%). However, it was associated with an increased risk of anastomotic complication (OR 1.71, 95% CI 1.15 to 2.54, P = 0.008), with no effect on perioperative mortality (OR 1.20, 95% CI 0.79 to 1.83, P = 0.40). Additionally, the prolonged interval failed to increase the pCR rate (OR 1.02, 95% CI 0.78 to 1.33, P = 0.89). Even worse, it was correlated with a decreased R0 resection rate (OR 0.60, 95% CI 0.41 to 0.88, P = 0.009) and increased positive CRM rate (OR 2.20, 95% CI 1.44 to 3.36, P < 0.001). This study suggests that the prolonged interval between nCRT and esophagectomy fails to result in better outcomes, and in fact, could worsen clinical outcomes, with increasing anastomotic complications, and undermine resection completeness. However, this conclusion should be treated with caution because of the limitations of retrospective cohort study and substantial clinical heterogeneity. (The study was registered at PRESPERO as CRD42016048210).
新辅助放化疗（nCRT）与食管癌切除术之间的间隔时间延长是否对诸如直肠癌等疾病有益，目前仍不清楚。因此，我们开展了本研究，以评估nCRT与食管癌切除术之间的间隔时间对食管癌患者临床结局的影响。检索了PubMed和Embase以确定符合条件的队列研究。主要结局为五年总生存率（OS），次要结局包括吻合口并发症的发生率、围手术期死亡率、病理完全缓解（pCR）率、环周切缘阳性（CRM）率和R0切除率。所有荟萃分析均使用随机效应模型，无论是否存在异质性。纳入了10项队列研究，共2383例患者。总体而言，汇总估计显示，间隔时间延长对五年OS无影响（优势比（OR）为0.87，95%置信区间为0.66至1.14，P = 0.30），异质性较低（PH = 0.78，I2 = 0%）。然而，它与吻合口并发症风险增加相关（OR为1.71，95%置信区间为1.15至2.54，P = 0.008），对围手术期死亡率无影响（OR为1.20，95%置信区间为0.79至1.83，P = 0.40）。此外，间隔时间延长未能提高pCR率（OR为1.02，95%置信区间为0.78至1.33，P = 0.89）。更糟糕的是，它与R0切除率降低（OR为0.60，95%置信区间为0.41至0.88，P = 0.009）和CRM阳性率增加（OR为2.20，95%置信区间为1.44至3.36，P < 0.001）相关。本研究表明，nCRT与食管癌切除术之间的间隔时间延长并不能带来更好的结局，实际上可能会使临床结局恶化，吻合口并发症增加，并影响切除的完整性。然而，由于回顾性队列研究的局限性和显著的临床异质性，该结论应谨慎对待。（该研究已在国际前瞻性系统评价注册平台（PRESPERO）注册，注册号为CRD42016048210）
