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 Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom.
Front Immunol. 2023 Jan 24;14:1117448. doi: 10.3389/fimmu.2023.1117448. eCollection 2023.
Significant progress has been made in the investigation of neoadjuvant immune-chemoradiotherapy (NICRT) and neoadjuvant immune-chemotherapy (NICT) on the outcomes of esophageal cancer patients. To summarize the current developments, a systematic review and meta-analysis were conducted to evaluate the efficacy and safety of neoadjuvant immunotherapy combined with chemoradiotherapy or chemotherapy.
A search strategy of prospective studies on esophageal cancer receiving neoadjuvant immunotherapy was predefined to scan PubMed, Embase, Cochrane, and additional major conferences for prospective studies. Efficacy was assessed by pathological complete response (pCR), major pathological response (MPR), and R0 resection rates. Safety was evaluated based on the incidence of grade ≥ 3 treatment-related adverse events (TRAEs), neoadjuvant therapy completion rate, surgical resection rate, and surgical delay rate. Differences between the NICRT and NICT groups were also analyzed.
A total of 38 studies qualified for the analysis. The pooled pCR, MPR, and R0 resection rates were 30, 58, and 99%, respectively. The pCR and MPR in the NICRT vs. NICT group were 38% vs. 28% (p=0.078) and 67% vs. 57% (p=0.181), respectively. The pooled incidence of grade ≥ 3 TRAEs was 24% (NICRT,58%, I = 61% vs. NICT,18%, I = 79%; p<0.001). In addition, the pooled neoadjuvant therapy completion and surgical resection rates were 92% and 85%, respectively; the difference was not statistically significant between the NICRT and NICT groups.
Neoadjuvant immunotherapy combined with chemoradiotherapy or chemotherapy is effective and safe in the short term for locally advanced esophageal cancer. However, further randomized trials are needed to confirm which combined model is more favorable.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021284266, identifier CRD42021284266.
新辅助免疫放化疗（NICRT）和新辅助免疫化疗（NICT）在食管癌患者的治疗效果方面取得了显著进展。为了总结目前的研究进展，我们进行了一项系统评价和荟萃分析，以评估新辅助免疫治疗联合放化疗或化疗的疗效和安全性。
我们预先设定了一个搜索策略，以扫描前瞻性研究，这些研究对象是接受新辅助免疫治疗的食管癌患者，检索范围包括 PubMed、Embase、Cochrane 和其他主要会议的前瞻性研究。通过病理完全缓解（pCR）、主要病理缓解（MPR）和 R0 切除率评估疗效。根据≥3 级治疗相关不良事件（TRAEs）的发生率、新辅助治疗完成率、手术切除率和手术延迟率评估安全性。还分析了 NICRT 组和 NICT 组之间的差异。
共有 38 项研究符合分析要求。汇总的 pCR、MPR 和 R0 切除率分别为 30%、58%和 99%。NICRT 组与 NICT 组的 pCR 和 MPR 分别为 38%和 28%（p=0.078）和 67%和 57%（p=0.181）。汇总的≥3 级 TRAEs 发生率为 24%（NICRT 组为 58%，I = 61%；NICT 组为 18%，I = 79%；p<0.001）。此外，汇总的新辅助治疗完成率和手术切除率分别为 92%和 85%，NICRT 组与 NICT 组之间的差异无统计学意义。
新辅助免疫治疗联合放化疗或化疗在短期内对局部晚期食管癌有效且安全。然而，需要进一步的随机试验来确认哪种联合模式更有利。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021284266，标识符 CRD42021284266。
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