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Meta-Analysis
. 2018 Aug 17;16(1):172.
doi: 10.1186/s12957-018-1470-y.

The role of definitive chemoradiotherapy versus surgery as initial treatments for potentially resectable esophageal carcinoma

Ming-Wei Ma  1 , Xian-Shu Gao  2 , Xiao-Bin Gu  1 , Mu Xie  1 , Ming Cui  1 , Min Zhang  1 , Ling Liu  1 , Huan Yin  3 , Long-Qi Chen  4
Affiliations
Meta-Analysis

The role of definitive chemoradiotherapy versus surgery as initial treatments for potentially resectable esophageal carcinoma

Ming-Wei Ma et al. World J Surg Oncol. .

Abstract

Background: We performed a meta-analysis to compare the efficacy of definitive chemoradiotherapy (dCRT) and esophagectomy as initial treatments for potentially resectable esophageal cancer.

Methods: To assess both strategies, the combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Thirteen studies (N = 2071; dCRT = 869 and surgery = 1202) were included. In all, 90.39% of the patients were diagnosed with esophageal squamous cell carcinoma (ESCC).

Results: The 2-year (OR = 1.199, 95% CI 0.922-1.560; P = 0.177) and 5-year overall survival (OS) rates (OR = 0.947, 95% CI 0.628-1.429; P = 0.796) were not significantly different. No significant differences were identified in the 2-year OS among patients with stage I disease (OR = 1.397, 95% CI 0.740-2.638; P = 0.303) or stage II-III (OR = 0.418, 95% CI 0.022-7.833; P = 0.560). Patients with lymph node metastases tended to have a better 5-year OS when treated with dCRT than with surgery (OR = 0.226, 95% CI 0.044-1.169; P = 0.076); however, the difference between the two methods was not significant. Western patients who received dCRT had poorer prognoses than patients who underwent surgery (OR = 1.522, 95% CI 1.035-2.238; P = 0.033). dCRT and surgery led to similar 5-year progression-free survival rates (OR = 1.06, 95% CI 0.79-1.42; P = 0.70).

Conclusions: dCRT and surgery are equally effective as initial treatments for potentially resectable esophageal cancer. These results apply primarily to Asian populations as they have an increased incidence of ESCC.

Keywords: Definitive chemoradiotherapy; Esophageal cancer; Esophagostomy; Meta-analysis; Survival.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram for article selection
Fig. 2
Fig. 2
Forest plot comparison of the ORs of the OS between the dCRT and surgery arms. a The OR of the 2-year OS was 1.199 (95% CI 0.922–1.560; P = 0.177). Publication bias test: P = 0.640 (Begg’s test); P = 0.240 (Egger’s test). Weights are from fixed-effects analyses. b The OR of the 5-year OS was 0.947 (95% CI 0.628–1.429; P = 0.796). Publication bias test: P = 0.161 (Begg’s test), P = 0.236 (Egger’s test). Weights are from random-effects analyses
Fig. 3
Fig. 3
Forest plot comparison of the ORs of the OS between the dCRT and surgery arms for patients with ESCC. The OR of the 5-year OS was 1.015 (95% CI 0.623–1.652; P = 0.954). Publication bias test: P = 0.348 (Begg’s test), P = 0.350 (Egger’s test). Weights are from random-effects analyses
Fig. 4
Fig. 4
Forest plot comparison of the ORs of the OS between the dCRT and surgery arms for patients with different stages of esophageal cancer. The OR of the 2-year OS for stage I esophageal cancer was 1.397 (95% CI 0.740–2.638; P = 0.303). Publication bias test: P = 0.133 (Begg’s test), P = 0.039 (Egger’s test). The OR of the 2-year OS for stage II–III esophageal cancer was 0.418 (95% CI 0.022–7.833; P = 0.560). Publication bias (not available due to lack of studies). Weights are from random-effects analyses
Fig. 5
Fig. 5
Forest plot comparison of the ORs of the OS between the dCRT and surgery arms for patients with N0 disease and N+ diseases. The OR of the 5-year OS for N0 disease was 1.419 (95% CI 0.613–3.289; P = 0.414). Publication bias: not available due to lack of studies. The OR of the 5-year OS for N+ disease was 0.226 (95% CI 0.044–1.169; P = 0.076). Publication bias: not available due to lack of studies. Weights are from random-effects analyses
Fig. 6
Fig. 6
Forest plot comparison of ORs of the OS between the dCRT and surgery arms for Asian patients and Western patients. The OR of the 2-year OS for Asian patients was 0.970 (95% CI 0.674–1.395; P = 0.868). Publication bias test: P = 0.835 (Begg’s test); P = 0.807 (Egger’s test). The OR of the 2-year OS for Western patients was 1.522 (95% CI 1.035–2.238; P = 0.033). Publication bias: not available due to lack of studies. Weights are from fixed-effects analyses
Fig. 7
Fig. 7
Forest plot comparison of ORs of the PFS between the dCRT and surgery arms. The OR of the 5-year PFS was 1.060 (95% CI 0.789–1.424; P = 0.698). Publication bias test: P = 0.260 (Begg’s test); P = 0.350 (Egger’s test). Weights are from fixed-effects analyses
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