Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.
Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada.
Ann Surg. 2022 Jan 1;275(1):91-98. doi: 10.1097/SLA.0000000000005227.
The aim of this study was to analyze esophageal cancer patients who previously underwent neoadjuvant therapy followed by a curative resection to determine whether additional adjuvant therapy is associated with improved survival outcomes.
Neoadjuvant therapy followed by surgery is the standard of care for locally advanced esophageal cancer, whereas adjuvant therapy is typically employed for patients with residual disease. However, the role of adjuvant therapy after a curative resection is still uncertain.
MEDLINE, EMBASE, and CENTRAL databases were searched for studies comparing patients with esophageal cancer who underwent neoadjuvant therapy and curative resection with and without adjuvant therapy. Primary outcome was overall survival (OS), and random effects meta-analysis was conducted where appropriate. Grading of recommendations, assessment, development, and evaluation was used to assess the certainty of evidence.
Ten studies involving 6462 patients were included. When compared to patients who received neoadjuvant therapy and esophagectomy alone, adjuvant therapy groups experienced a significant decrease in mortality by 48% at 1 year (Risk Ratio (RR) 0.52, 95% confidence interval [CI] 0.41-0.65, P < 0.001, moderate certainty). This reduction in mortality was carried through to 5-year follow-up (RR 0.91, 95% CI 0.86-0.96, P < 0.001, moderate certainty). The difference between the adjuvant therapy and the control group was uncertain regarding the secondary outcomes.
Adjuvant therapy after neoadjuvant treatment and esophagectomy with negative resection margins provide an improved OS at 1 and 5 years with moderate to high certainty of evidence, but the benefit for disease-free survival and locoregional/distal recurrence remain uncertain due to limited reporting of these outcomes.
本研究旨在分析接受新辅助治疗后行根治性切除术的食管癌患者，以确定辅助治疗是否与改善生存结局相关。
新辅助治疗后手术是局部晚期食管癌的标准治疗方法，而辅助治疗通常用于有残留疾病的患者。然而，根治性切除术后辅助治疗的作用仍不确定。
检索 MEDLINE、EMBASE 和 CENTRAL 数据库，比较接受新辅助治疗和根治性切除术的食管癌患者，并比较有无辅助治疗的患者。主要结局为总生存（OS），并在适当情况下进行随机效应荟萃分析。使用推荐评估、制定与评价分级（Grading of Recommendations, Assessment, Development, and Evaluation，GRADE）评估证据确定性。
纳入 10 项研究，共 6462 例患者。与仅接受新辅助治疗和食管切除术的患者相比，辅助治疗组 1 年死亡率显著降低 48%（风险比[RR]0.52，95%置信区间[CI]0.41-0.65，P<0.001，中等确定性）。这种死亡率降低持续到 5 年随访（RR 0.91，95% CI 0.86-0.96，P<0.001，中等确定性）。关于次要结局，辅助治疗组与对照组之间的差异不确定。
新辅助治疗后行根治性切除术且切缘阴性的患者，辅助治疗可改善 1 年和 5 年 OS，证据确定性为中至高，但无病生存和局部/远处复发的获益仍不确定，因为这些结局的报告有限。
