Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Thoracic Surgery, Mount Sinai Health System, New York, New York; Valley/Mount Sinai Comprehensive Cancer Care, Paramus, New Jersey.
Ann Thorac Surg. 2019 Sep;108(3):935-944. doi: 10.1016/j.athoracsur.2019.04.008. Epub 2019 May 8.
The optimal approach to clinical T2N0 (cT2N0) esophageal cancer is unclear. Our objective is to perform a systematic review investigating whether neoadjuvant therapy results in better outcomes compared with upfront surgery in cT2N0 esophageal cancer.
We performed a systematic review and meta-analysis of randomized and nonrandomized studies (1995 to 2017) comparing use of neoadjuvant therapy with upfront surgery in the treatment of cT2N0 esophageal cancer. Independent and duplicate assessment was used. All meta-analytical techniques were performed in RevMan 5.3.
Nine cohort studies, including 5433 patients, were included for meta-analysis. Use of neoadjuvant therapy was associated with significantly higher complete resection rates compared with upfront surgery (risk ratio, 0.67; 95% confidence interval, 0.55 to 0.81; P < .001). There was no difference in 5-year overall or recurrence-free survival. There were no significant differences in perioperative mortality as well as perioperative complications, although meta-analysis results are limited by inconsistent reporting of such complications. Lymphovascular invasion and larger tumor size were significant predictors of upstaging. Four of the studies were at high risk of bias. The remaining 5 studies were larger and more robust but were assessed as being of uncertain risk of bias.
Use of neoadjuvant therapy was associated with significantly higher complete resection rates compared with upfront surgery although this did not translate to differences in survival outcomes. No differences in perioperative morbidity or mortality were identified. Based on qualitative systematic review, lymphovascular invasion and larger tumor size are potential factors for helping to select those patients who may benefit from neoadjuvant therapy.
临床 T2N0（cT2N0）食管癌的最佳治疗方法尚不清楚。我们的目的是进行一项系统评价，以调查新辅助治疗与 cT2N0 食管癌的直接手术相比是否能带来更好的结果。
我们对比较新辅助治疗与直接手术治疗 cT2N0 食管癌的随机和非随机研究（1995 年至 2017 年）进行了系统评价和荟萃分析。使用独立且重复的评估。所有的荟萃分析技术均在 RevMan 5.3 中进行。
纳入了 9 项队列研究，共 5433 例患者进行荟萃分析。与直接手术相比，新辅助治疗可显著提高完全切除率（风险比，0.67；95%置信区间，0.55 至 0.81；P<0.001）。5 年总生存率和无复发生存率无差异。围手术期死亡率和围手术期并发症也无显著差异，尽管荟萃分析结果受到此类并发症报告不一致的限制。淋巴管血管侵犯和肿瘤较大是升级的显著预测因素。其中 4 项研究存在高偏倚风险，其余 5 项研究规模更大且更稳健，但被评估为偏倚风险不确定。
与直接手术相比，新辅助治疗可显著提高完全切除率，但这并未转化为生存结果的差异。围手术期发病率或死亡率无差异。基于定性系统评价，淋巴管血管侵犯和肿瘤较大可能是有助于选择可能受益于新辅助治疗的患者的潜在因素。
