Department of Radiation Oncology, Peking University First Hospital, No.7 Xishiku Street, Beijing, 100034, People's Republic of China.
Department of Medical and Pharmaceutical Science and Technology Strategy Research, Institute of Medical Information, Chinese Academy of Medical Sciences, No. 3 Yabao Road, Beijing, China.
World J Surg Oncol. 2018 Aug 17;16(1):172. doi: 10.1186/s12957-018-1470-y.
We performed a meta-analysis to compare the efficacy of definitive chemoradiotherapy (dCRT) and esophagectomy as initial treatments for potentially resectable esophageal cancer.
To assess both strategies, the combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Thirteen studies (N = 2071; dCRT = 869 and surgery = 1202) were included. In all, 90.39% of the patients were diagnosed with esophageal squamous cell carcinoma (ESCC).
The 2-year (OR = 1.199, 95% CI 0.922-1.560; P = 0.177) and 5-year overall survival (OS) rates (OR = 0.947, 95% CI 0.628-1.429; P = 0.796) were not significantly different. No significant differences were identified in the 2-year OS among patients with stage I disease (OR = 1.397, 95% CI 0.740-2.638; P = 0.303) or stage II-III (OR = 0.418, 95% CI 0.022-7.833; P = 0.560). Patients with lymph node metastases tended to have a better 5-year OS when treated with dCRT than with surgery (OR = 0.226, 95% CI 0.044-1.169; P = 0.076); however, the difference between the two methods was not significant. Western patients who received dCRT had poorer prognoses than patients who underwent surgery (OR = 1.522, 95% CI 1.035-2.238; P = 0.033). dCRT and surgery led to similar 5-year progression-free survival rates (OR = 1.06, 95% CI 0.79-1.42; P = 0.70).
dCRT and surgery are equally effective as initial treatments for potentially resectable esophageal cancer. These results apply primarily to Asian populations as they have an increased incidence of ESCC.
我们进行了一项荟萃分析，比较了根治性放化疗（dCRT）和手术作为潜在可切除食管癌初始治疗的疗效。
为了评估这两种策略，我们计算了合并优势比（ORs）和 95%置信区间（CIs）。共纳入 13 项研究（N=2071；dCRT=869 例，手术=1202 例）。所有患者中 90.39%诊断为食管鳞状细胞癌（ESCC）。
2 年（OR=1.199，95%CI 0.922-1.560；P=0.177）和 5 年总生存率（OS）率（OR=0.947，95%CI 0.628-1.429；P=0.796）无显著差异。I 期疾病患者（OR=1.397，95%CI 0.740-2.638；P=0.303）或 II-III 期患者（OR=0.418，95%CI 0.022-7.833；P=0.560）2 年 OS 无显著差异。有淋巴结转移的患者接受 dCRT 治疗的 5 年 OS 倾向于优于手术（OR=0.226，95%CI 0.044-1.169；P=0.076）；然而，两种方法之间的差异无统计学意义。接受 dCRT 的西方患者预后比接受手术的患者差（OR=1.522，95%CI 1.035-2.238；P=0.033）。dCRT 和手术导致相似的 5 年无进展生存率（OR=1.06，95%CI 0.79-1.42；P=0.70）。
dCRT 和手术作为潜在可切除食管癌的初始治疗同样有效。这些结果主要适用于亚洲人群，因为他们 ESCC 的发病率更高。
