Department of Oncology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, China.
Medicine (Baltimore). 2024 Jan 19;103(3):e36785. doi: 10.1097/MD.0000000000036785.
Currently, the optimal treatment for neoadjuvant therapy for locally advanced esophageal cancer is not clear, and there is no evidence that neoadjuvant chemoradiotherapy (nCRT) is superior to neoadjuvant chemotherapy (nCT). Due to the publication of new clinical trials and defects in previous meta-analyses, we conducted an updated meta-analysis to evaluate the efficacy and safety of nCRT and nCT.
The following databases were searched for studies: PubMed, EMBASE, and Cochrane library (updated to April 22, 2023). All randomized trials comparing nCRT with nCT in locally advanced esophageal cancer met the inclusion criteria. Data were analyzed using Review Manager 5.4.1 (Cochrane collaboration software). Primary outcomes assessed from the trials included overall survival (OS), progression-free survival (PFS), pathological complete response (pCR), R0 resection rate, postoperative complications, postoperative mortality, and grade 3 or higher adverse events (3 + AEs).
This systematic review and meta-analysis included 7 randomized controlled studies involving 1372 patients (686 receiving nCRT and 686 receiving nCT). Compared with nCT, nCRT significantly improved OS (HR = 0.80; 95% CI: 0.68-0.94), PFS (HR = 0.78; 95% CI: 0.66-0.93), pCR (OR = 13.00; 95% CI: 7.82-21.61) and R0 resection (OR = 1.84; 95% CI: 1.32-2.57), but was associated with higher postoperative mortality (OR = 2.31; 95% CI: 1.26-4.25) and grade 3 + AEs (OR = 2.21; 95% CI: 1.36-3.58). There was no significant difference in postoperative complications between nCRT and nCT (OR = 1.15; 95% CI: 0.82-1.61). Subgroup analysis showed significant survival benefit in squamous cell carcinoma (HR = 0.80; 95% CI: 0.68-0.98), but not in adenocarcinoma (HR = 0.80; 95% CI: 0.63-1.08).
Our meta-analysis found superior efficacy associated with nCRT compared with nCT in both tumor regression and prolonged survival, but increased the risk of postoperative mortality and grade 3 + AEs. Esophageal squamous cell carcinoma was more likely to benefit from nCRT than esophageal adenocarcinoma in the term of OS.
目前，局部晚期食管癌新辅助治疗的最佳治疗方法尚不清楚，也没有证据表明新辅助放化疗（nCRT）优于新辅助化疗（nCT）。由于新的临床试验的发表和之前荟萃分析的缺陷，我们进行了一项更新的荟萃分析，以评估 nCRT 和 nCT 的疗效和安全性。
检索了以下数据库中的研究：PubMed、EMBASE 和 Cochrane 图书馆（更新至 2023 年 4 月 22 日）。所有比较局部晚期食管癌 nCRT 与 nCT 的随机试验均符合纳入标准。使用 Review Manager 5.4.1（Cochrane 协作软件）分析数据。从试验中评估的主要结局包括总生存期（OS）、无进展生存期（PFS）、病理完全缓解（pCR）、R0 切除率、术后并发症、术后死亡率和 3 级或更高的不良事件（3+AE）。
本系统评价和荟萃分析纳入了 7 项随机对照研究，涉及 1372 名患者（686 名接受 nCRT，686 名接受 nCT）。与 nCT 相比，nCRT 显著改善了 OS（HR=0.80；95%CI：0.68-0.94）、PFS（HR=0.78；95%CI：0.66-0.93）、pCR（OR=13.00；95%CI：7.82-21.61）和 R0 切除率（OR=1.84；95%CI：1.32-2.57），但与较高的术后死亡率（OR=2.31；95%CI：1.26-4.25）和 3 级或更高的 AE（OR=2.21；95%CI：1.36-3.58）相关。nCRT 和 nCT 之间的术后并发症无显著差异（OR=1.15；95%CI：0.82-1.61）。亚组分析显示，在鳞状细胞癌中具有显著的生存获益（HR=0.80；95%CI：0.68-0.98），但在腺癌中没有（HR=0.80；95%CI：0.63-1.08）。
我们的荟萃分析发现，与 nCT 相比，nCRT 在肿瘤消退和延长生存方面具有更好的疗效，但增加了术后死亡率和 3 级或更高的 AE 的风险。在 OS 方面，食管鳞状细胞癌比食管腺癌更有可能从 nCRT 中获益。
