Schiefer Sabine, Crnovrsanin Nerma, Kalkum Eva, Vey Johannes A, Nienhüser Henrik, Rompen Ingmar F, Haag Georg M, Müller-Stich Beat, Billmann Franck, Schmidt Thomas, Probst Pascal, Klotz Rosa, Sisic Leila
Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Department of Pathology, Netherlands Cancer Institute (NKI), Amsterdam, Netherlands.
Front Surg. 2024 May 6;11:1382039. doi: 10.3389/fsurg.2024.1382039. eCollection 2024.
The impact of neoadjuvant chemotherapy (nCTX) on survival and tumor response in patients with esophagogastric signet ring cell carcinoma (SRCC) is still controversial.
Two independent reviewers performed a systematic literature search in Medline, CENTRAL, and Web of Science including prospective and retrospective two-arm non-randomized and randomized controlled studies (RCTs). Data was extracted on overall survival (OS) and tumor regression in resected esophagogastric SRCC patients with or without nCTX. Survival data was analyzed using published hazard ratios (HR) if available or determined it from other survival data or survival curves. OS and histopathological response rates by type of tumor (SRCC vs. non-SRCC) were also investigated.
Out of 559 studies, ten (1 RCT, 9 non-RCTs) were included in this meta-analysis (PROSPERO CRD42022298743) investigating 3,653 patients in total. The four studies investigating survival in SRCC patients treated with nCTX + surgery vs. surgery alone showed no survival benefit for neither intervention, but heterogeneity was considerable (HR, 1.01; 95% CI, 0.61-1.67; = 0.98; = 89%). In patients treated by nCTX + surgery SRCC patients showed worse survival (HR, 1.45; 95% CI, 1.21-1.74; < 0.01) and lower rate of major histopathological response than non-SRCC patients (OR, 2.47; 95% CI, 1.78-3.44; < 0.01).
The current meta-analysis could not demonstrate beneficial effects of nCTX for SRCC patients. Histopathological response to and survival benefits of non-taxane-based nCTX seem to be lower in comparison to non-SRC esophagogastric cancer. However, certainty of evidence is low due to the scarcity of high-quality trials. Further research is necessary to determine optimal treatment for SRCC patients.
https://www.crd.york.ac.uk/, PROSPERO (CRD42022298743).
新辅助化疗（nCTX）对食管胃印戒细胞癌（SRCC）患者生存及肿瘤反应的影响仍存在争议。
两名独立评审员在Medline、CENTRAL和Web of Science数据库中进行了系统文献检索，纳入前瞻性和回顾性双臂非随机及随机对照研究（RCT）。提取了接受或未接受nCTX的食管胃SRCC切除患者的总生存（OS）和肿瘤退缩数据。若有可用的已发表风险比（HR），则使用其分析生存数据；若无，则根据其他生存数据或生存曲线确定。还研究了按肿瘤类型（SRCC与非SRCC）划分的OS和组织病理学反应率。
在559项研究中，10项（1项RCT，9项非RCT）纳入了本荟萃分析（PROSPERO注册号CRD42022298743），共纳入3653例患者。四项比较nCTX联合手术与单纯手术治疗SRCC患者生存情况的研究显示，两种干预措施均未显示出生存获益，但异质性较大（HR = 1.01；95%CI：0.61 - 1.67；I² = 0.98；P = 0.89%）。在接受nCTX联合手术治疗的患者中，SRCC患者的生存情况更差（HR = 1.45；95%CI：1.21 - 1.74；P < 0.01），主要组织病理学反应率低于非SRCC患者（OR = 2.47；95%CI：1.78 - 3.44；P < 0.01）。
当前的荟萃分析未能证明nCTX对SRCC患者有有益作用。与非SRCC的食管胃癌相比，基于非紫杉烷的nCTX的组织病理学反应和生存获益似乎更低。然而，由于高质量试验稀缺，证据的确定性较低。有必要进行进一步研究以确定SRCC患者的最佳治疗方案。
