Ma Hai-Feng, Lv Guo-Xiao, Cai Zhong-Fang, Zhang Da-Hai
Department of Radiotherapy, Dongyang People's Hospital, Dongyang, Zhejiang, China.
Onco Targets Ther. 2018 Jun 14;11:3441-3447. doi: 10.2147/OTT.S145063. eCollection 2018.
Resection remains the best treatment for carcinoma of the esophagus in terms of local control, but local recurrence and distant metastasis remain an issue after surgery. Chemo-radiotherapy (CRT) followed by surgery was associated with significantly improved survival benefit, but the effectiveness of neoadjuvant therapy in patients with resectable esophageal carcinoma remains controversial. The aim of this study was to evaluate the effects of neoadjuvant chemoradiotherapy in resectable esophageal carcinoma compared to surgery alone (SA).
A search for publications that compared the efficacy of CRT with SA in resectable esophageal carcinoma was conducted. After a rigorous review of the quality, the data were extracted from eligible trials. The major outcomes measures were odds ratios (ORs). The ORs with their corresponding 95% confidence intervals were the principal measure of effects. For the meta-analysis, Revman 5.3 software was used to analyze the combined pooled ORs using fixed- or random-effects models according to the heterogeneity.
Our findings revealed that, compared with SA, neoadjuvant CRT was associated with improved overall survival (OS) and progression-free survival times, but the 3- and 5-year OS did not show a statistical difference (≥0.05). The adjuvant chemotherapy group did not show significant improvement on reference rate and metastasis rate compared with the control group.
CRT does significantly improve progression-free survival and OS in patients with esophageal cancer compared with SA. However, further assessment is still warranted on the role of CRT in future trials with well-selected patients.
就局部控制而言，手术切除仍是食管癌的最佳治疗方法，但术后局部复发和远处转移仍是一个问题。化疗联合放疗（CRT）后行手术与显著改善生存获益相关，但新辅助治疗在可切除食管癌患者中的有效性仍存在争议。本研究的目的是评估新辅助放化疗与单纯手术（SA）相比在可切除食管癌中的效果。
检索比较CRT与SA在可切除食管癌中疗效的文献。在严格评估质量后，从符合条件的试验中提取数据。主要结局指标为比值比（OR）。OR及其相应的95%置信区间是效应的主要衡量指标。对于荟萃分析，使用Revman 5.3软件根据异质性采用固定效应或随机效应模型分析合并的汇总OR。
我们的研究结果显示，与SA相比，新辅助CRT与总体生存期（OS）和无进展生存期的改善相关，但3年和5年OS未显示统计学差异（≥0.05）。辅助化疗组与对照组相比，在参考率和转移率方面未显示出显著改善。
与SA相比，CRT确实能显著改善食管癌患者的无进展生存期和OS。然而，在未来针对精心挑选患者的试验中，仍有必要对CRT的作用进行进一步评估。
