Ma Zeliang, Yuan Meng, Bao Yongxing, Wang Yang, Men Yu, Hui Zhouguang
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2021 Oct 20;11:728185. doi: 10.3389/fonc.2021.728185. eCollection 2021.
The optimal treatment for resectable esophageal squamous cell carcinoma (ESCC) remains controversial. Surgery is the primary treatment but with poor results. Attempts to improve patient survival have been made by introducing chemotherapy, radiotherapy, or both. However, randomized comparisons for all these strategies are not always available. This network meta-analysis compared the overall survival of neoadjuvant and adjuvant therapy with surgery alone to identify the most effective approach.
We systematically searched electronic databases (PubMed, Embase, and Cochrane Library) for relevant studies published before April 2021. Only phase II and III randomized controlled trials comparing the following treatments were included: surgery alone, neoadjuvant chemotherapy (NCT), radiotherapy (NRT) or chemoradiotherapy (NCRT), adjuvant chemotherapy (ACT), radiotherapy (ART), or chemoradiotherapy (ACRT). The hazard ratios (HR) and 95% confidence intervals (CIs) of overall survival (OS) was identified as the measurement of effectiveness. A network meta-analysis was conducted to synthesize the evidence under the Bayesian framework, and the relative effects of all possible comparisons were made. The ranking analysis was performed to support the decision in clinical practice.
A total of 19 relevant trials with 3,749 patients were identified. Compared with surgery alone, NCRT (HR 0.76, 95% CI 0.65-0.89) and NCT (HR 0.81, 95% CI 0.70-0.94) significantly improved OS, while other treatments, including NRT (HR 0.86, 95% CI 0.66-1.08), ACRT (HR 0.73, 95% CI 0.49-1.08), ACT (HR 0.96, 95% CI 0.75-1.21), and ART (HR 0.86, 95% CI 0.66-1.14), provided no significant survival advantage. None of the neoadjuvant and adjuvant treatments showed a statistically significant difference in OS to each other when compared in pairs.
For resectable esophageal squamous cell carcinoma, this network meta-analysis showed that NCRT may be the optimal strategy, NCT may be the second choice, while other multimodality treatments could not improve OS compared with surgery alone. It remains unclear whether ESCC will benefit from adding radiotherapy into the neoadjuvant treatment.
We registered this meta-analysis protocol at the prospective register of systematic reviews, PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172745 (Identification code: CRD42020172745).
可切除食管鳞状细胞癌（ESCC）的最佳治疗方案仍存在争议。手术是主要治疗方法，但效果不佳。人们尝试通过引入化疗、放疗或两者结合来提高患者生存率。然而，并非总能获得针对所有这些策略的随机对照比较。这项网状Meta分析比较了新辅助和辅助治疗与单纯手术的总生存率，以确定最有效的方法。
我们系统检索了电子数据库（PubMed、Embase和Cochrane图书馆），以查找2021年4月之前发表的相关研究。仅纳入比较以下治疗方法的II期和III期随机对照试验：单纯手术、新辅助化疗（NCT）、放疗（NRT）或放化疗（NCRT）、辅助化疗（ACT）、放疗（ART）或放化疗（ACRT）。将总生存率（OS）的风险比（HR）和95%置信区间（CI）确定为疗效衡量指标。在贝叶斯框架下进行网状Meta分析以综合证据，并对所有可能的比较进行相对效应分析。进行排序分析以支持临床实践中的决策。
共确定了19项相关试验，涉及3749例患者。与单纯手术相比，NCRT（HR 0.76，95%CI 0.65 - 0.89）和NCT（HR 0.81，95%CI 0.70 - 0.94）显著改善了OS，而其他治疗方法，包括NRT（HR 0.86，95%CI 0.66 - 1.08）、ACRT（HR 0.73，95%CI 0.49 - 1.08）、ACT（HR 0.96，95%CI 0.75 - 1.21）和ART（HR 0.86，95%CI 0.66 - 1.14），均未显示出显著的生存优势。新辅助和辅助治疗两两比较时，在OS方面均未显示出统计学上的显著差异。
对于可切除的食管鳞状细胞癌，这项网状Meta分析表明，NCRT可能是最佳策略，NCT可能是第二选择，而与单纯手术相比，其他多模式治疗并不能改善OS。尚不清楚ESCC在新辅助治疗中加入放疗是否会获益。
我们在系统评价前瞻性注册库PROSPERO（https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172745，识别码：CRD42020172745）上注册了该Meta分析方案。
