Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: a meta-analysis

Abstract

Aim: To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma.

Methods: We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed. Trial validity assessment was performed and a trial quality score was assigned.

Results: Eleven randomized controlled trials (RCTs) including 1308 patients were selected. Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone. Odds ratio (OR) [95% confidence interval (CI), P value], expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone, was 1.28 (1.01-1.64, P = 0.05) for 1-year survival, 1.78 (1.20-2.66, P = 0.004) for 3-year survival, and 1.46 (1.07-1.99, P = 0.02) for 5-year survival. Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy (OR: 1.68, 95% CI: 1.03-2.73, P = 0.04), but incidence of postoperative complications was similar in two groups (OR: 1.14, 95% CI: 0.88-1.49, P = 0.32). Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence (OR: 0.64, 95% CI: 0.41-0.99, P = 0.04), but incidence of distant cancer recurrence was similar (OR: 0.94, 95% CI: 0.68-1.31, P = 0.73). Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvant chemoradiotherapy, OR (95% CI, P value) was 1.16 (0.85-1.57, P = 0.34) for 1-year survival, 1.34 (0.98-1.82, P = 0.07) for 3-year survival and 1.41 (0.98-2.02, P = 0.06) for 5-year survival.

Conclusion: Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.

Keywords: Esophageal carcinoma; Meta-analysis; Neoadjuvant chemoradiotherapy; Randomized controlled trial.

Figure 1

Postoperative survival rate in neoadjuvant chemoradiotherapy and surgery compared with surgery alone. A: One-year survival; B: Three-year survival; C: Five-year survival. CRT + S: Neoadjuvant chemoradiotherapy and surgery; S: Surgery; OR: Odds ratio; CI: Confidence interval.

Figure 2

R0 resection rate in neoadjuvant chemoradiotherapy and surgery compared with surgery alone.

Figure 3

Postoperative mortality in neoadjuvant chemoradiotherapy and surgery compared with surgery alone.

Figure 4

Incidence of postoperative complication in neoadjuvant chemoradiotherapy and surgery compared with surgery alone.

Figure 5

Cancer recurrence after surgery in neoadjuvant chemoradiotherapy and surgery compared with surgery alone. A: Incidence of local-regional cancer recurrence; B: Incidence of distant cancer recurrence.