Ji Jianrui, Liu Yunsong, Bao Yongxing, Men Yu, Wang Jun, Hui Zhouguang
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 VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Adv Radiat Oncol. 2024 Apr 19;9(7):101522. doi: 10.1016/j.adro.2024.101522. eCollection 2024 Jul.
Initial studies investigating the combination of local and systemic treatments in advanced esophageal cancer (EC) have conflicting conclusions regarding survival benefits. The objective of this systematic review and meta-analysis is to assess the efficacy of the addition of local therapy to systemic treatments in patients with advanced EC.
A systematic literature search was conducted in the PubMed, EMBASE, and CENTRAL databases. Key eligibility criteria included studies that enrolled patients with histologically confirmed EC or esophagogastric junction cancer with metastasis or recurrence and compared survival benefits between the combined local and systemic treatment group and the systemic treatment alone group. Survival outcomes, represented by hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS), were pooled using a random effects model. The MINORS score was adopted for quality assessment. Risk of bias was statistically examined by Begg's and Egger's tests.
A total of 1 randomized controlled trial (RCT) and 10 qualified retrospective studies including 14,489 patients were identified. Addition of local therapy to systemic treatment significantly improved PFS (HR, 0.52; 95% CI, 0.37-0.73; < .001) and OS (HR, 0.69; 95% CI, 0.58-0.81; < .0001) compared with systemic treatment alone. The subgroup analysis revealed that combined local and systemic treatment conferred a significant survival advantage in both patients with oligometastasis (PFS: HR, 0.45; 95% CI, 0.31-0.64; < .0001; OS: HR, 0.62; 95% CI, 0.48-0.79; < .0001) and recurrence (OS: HR, 0.55; 95% CI, 0.37-0.81; = .002).
In conclusion, addition of local treatment to systemic therapy can improve survival in patients with advanced EC, particularly in those with oligometastasis or recurrent diseases.
初步研究探讨局部治疗与全身治疗联合用于晚期食管癌（EC）时，关于生存获益存在相互矛盾的结论。本系统评价和荟萃分析的目的是评估在晚期EC患者中，在全身治疗基础上加用局部治疗的疗效。
在PubMed、EMBASE和CENTRAL数据库中进行系统的文献检索。关键纳入标准包括纳入组织学确诊为EC或食管胃交界癌伴转移或复发的患者，并比较局部与全身联合治疗组和单纯全身治疗组之间的生存获益。以无进展生存期（PFS）和总生存期（OS）的风险比（HR）表示的生存结局，采用随机效应模型进行汇总。采用MINORS评分进行质量评估。通过Begg检验和Egger检验对偏倚风险进行统计学检验。
共纳入1项随机对照试验（RCT）和10项合格的回顾性研究，包括14489例患者。与单纯全身治疗相比，在全身治疗基础上加用局部治疗显著改善了PFS（HR，0.52；95%CI，0.37 - 0.73；P <.001）和OS（HR，0.69；95%CI，0.58 - 0.81；P <.0001）。亚组分析显示，局部与全身联合治疗在寡转移患者（PFS：HR，0.45；95%CI，0.31 - 0.64；P <.0001；OS：HR，0.62；95%CI，0.48 - 0.79；P <.0001）和复发患者（OS：HR，0.55；95%CI，0.37 - 0.81；P =.002）中均具有显著的生存优势。
总之，在全身治疗基础上加用局部治疗可改善晚期EC患者生存，尤其是寡转移或复发患者。
