Sun Zhiyong, Zheng Jiajie, Xu Xin, Zhao Xiaojing, Ma Xiumei, Ye Qing
Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Ann Transl Med. 2022 Dec;10(24):1378. doi: 10.21037/atm-22-6186.
Although the clinical complete response (cCR) for esophageal cancer patients after neoadjuvant chemoradiotherapy (nCRT) may be related to the good survival prognosis, the choice of conservative and surgical treatments is still controversial. This study sought to compare the clinical outcomes of these two treatments.
A systematic search was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of the PubMed, Embase, and Cochrane Library databases to retrieve articles published between January 1, 2010 and March 31, 2022 on the efficacy of conservative treatment or surgery in esophageal cancer patients who had achieved a cCR after nCRT The predominant endpoints were overall survival (OS), disease-free-survival (DFS), local recurrence, and distant metastasis. Odds ratios (ORs) were generated for the dichotomous variants by meta-analysis. The software implemented was Stata 16.0 MP. This research was prospectively registered under PROSPERO (registration number: CRD42022332143).
Ultimately, eight retrospective cohort studies and one randomized controlled trial, comprising 749 patients (nCRT group: 333 and nCRT + surgery group: 416), were included in the meta-analysis after two researchers independently assessed the risk of bias for all included studies. The 2-year OS [OR =1.239, 95% confidence interval (CI): 0.891 to 1.723] and 5-year OS (OR =1.369, 95% CI: 0.963 to 1.947) were comparable between the nCRT group and nCRT plus surgery (nCRT + S) group. Patients in the nCRT + S group had significantly longer DFS (2 and 5 years, OR ranging from 0.303 to 0.357) and lower local recurrence rate (OR =0.179, 95% CI: 0.104 to 0.291) than those in the nCRT group. However, the distant metastasis rate was similar between the nCRT group and the nCRT + S group.
Esophageal cancer patients who achieved a cCR after nCRT and received an esophagectomy had better DFS and lower local recurrence than those who received conservative treatment; however, this DFS advantage did not lead to a significant difference in OS. Salvage surgery may be a feasible option for resectable patients who have local recurrence after achieving cCR.
尽管新辅助放化疗（nCRT）后食管癌患者的临床完全缓解（cCR）可能与良好的生存预后相关，但保守治疗和手术治疗的选择仍存在争议。本研究旨在比较这两种治疗方法的临床疗效。
根据系统评价与Meta分析的首选报告项目（PRISMA）指南，对PubMed、Embase和Cochrane图书馆数据库进行系统检索，以获取2010年1月1日至2022年3月31日期间发表的关于nCRT后达到cCR的食管癌患者保守治疗或手术疗效的文章。主要终点为总生存期（OS）、无病生存期（DFS）、局部复发和远处转移。通过Meta分析生成二分变量的比值比（OR）。使用的软件为Stata 16.0 MP。本研究已在国际前瞻性系统评价注册库（PROSPERO）上进行前瞻性注册（注册号：CRD42022332143）。
最终，在两名研究人员独立评估了所有纳入研究的偏倚风险后，8项回顾性队列研究和1项随机对照试验被纳入Meta分析，共749例患者（nCRT组：333例，nCRT + 手术组：416例）。nCRT组与nCRT加手术（nCRT + S）组的2年总生存期[OR = 1.239，95%置信区间（CI）：0.891至1.723]和5年总生存期（OR = 1.369，95% CI：0.963至1.947）相当。nCRT + S组患者的DFS（2年和5年，OR范围为0.303至0.357）显著长于nCRT组，局部复发率低于nCRT组（OR = 0.179，95% CI：0.104至0.291）。然而，nCRT组和nCRT + S组的远处转移率相似。
nCRT后达到cCR并接受食管切除术的食管癌患者比接受保守治疗的患者具有更好的DFS和更低的局部复发率；然而，这种DFS优势并未导致OS有显著差异。挽救性手术可能是cCR后出现局部复发的可切除患者的一种可行选择。
