Department of Thoracic Surgery, Gaozhou People's Hospital Affiliated to Guangdong Medical University, Maoming, China.
Department of Cardiothoracic Surgery, Guangdong Medical University, Zhanjiang, China.
Asian J Surg. 2024 Sep;47(9):3827-3840. doi: 10.1016/j.asjsur.2024.02.099. Epub 2024 Mar 5.
Surgery after neoadjuvant chemoradiotherapy remains the gold standard for the treatment of resectable esophageal cancer (EC); however, chemoradiotherapy without surgery has been recommended in specific cases. The aim of this meta-analysis is to analyse the survival between surgeries after neoadjuvant chemoradiotherapy compared with definitive chemoradiotherapy in order to provide a theoretical basis for clinically individualised differential treatment. We conducted an initial search of MEDLINE (PubMed), the Cochrane Library, and Embase for English-only articles that compared treatment regimens and provided survival data. According to the final I2 value of the two survival indicators, the random effect model or fixed effect model was used to calculate the overall hazard ratio (HR) and 95% confidence intervals (CI). Cochrane's Q test was used to judge the heterogeneity of the studies, and a funnel plot was used to evaluate for publication bias. A sensitivity analysis was performed to verify the stability of the included studies. A total of 38 studies involving 29161 patients (neoadjuvant therapy: 15401, definitive chemoradiotherapy: 13760) were included in the analysis. The final pooled results (HR = 0.74, 95% CI: 0.67-0.82) showed a statistically significant increase in overall survival with neoadjuvant chemoradiotherapy plus surgery compared with definitive chemoradiotherapy. Subgroup analyses were performed to determine the effects of heterogeneity, additional treatment regimens, study types, and geographic regions, as well as histologic differences, complications, and recurrence, on the overall results. For people with esophageal cancer that can be removed, neoadjuvant chemoradiotherapy combined with surgery improves survival compared to definitive chemoradiotherapy. However, more research is needed to confirm these results and help doctors make decisions about treatment.
新辅助放化疗后手术仍然是可切除食管癌（EC）治疗的金标准；然而，在某些特定情况下，不进行手术的放化疗也被推荐。本荟萃分析旨在分析新辅助放化疗后手术与单纯放化疗之间的生存差异，为临床个体化治疗提供理论依据。我们对 MEDLINE（PubMed）、Cochrane 图书馆和 Embase 进行了初步检索，以查找比较治疗方案并提供生存数据的仅英文文章。根据两个生存指标的最终 I2 值，使用随机效应模型或固定效应模型计算总体风险比（HR）和 95%置信区间（CI）。使用 Cochrane's Q 检验判断研究的异质性，并使用漏斗图评估发表偏倚。进行敏感性分析以验证纳入研究的稳定性。共纳入 38 项研究，涉及 29161 例患者（新辅助治疗：15401 例，单纯放化疗：13760 例）。最终汇总结果（HR=0.74，95%CI：0.67-0.82）表明，与单纯放化疗相比，新辅助放化疗联合手术可显著提高总体生存率。进行了亚组分析，以确定异质性、附加治疗方案、研究类型和地理区域以及组织学差异、并发症和复发对总体结果的影响。对于可切除的食管癌患者，新辅助放化疗联合手术可提高生存，优于单纯放化疗。然而，还需要更多的研究来证实这些结果，并帮助医生做出治疗决策。
