Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer
Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer
复制标题
DOI：
10.1002/bjs.7455
复制
发表时间：
2011-06-01
影响因子：
9.6
通讯作者：
Buechler, P.
中科院分区：
文献类型：
--
作者：
Kranzfelder, M.;Schuster, T.;Buechler, P.
背景：可切除的食管鳞状细胞癌（OSCC）的标准治疗是手术切除并充分淋巴结清扫。大多数西方患者接受新辅助化疗或放化疗（CRT）。近年来，一些患者仅接受CRT（确定性CRT，dCRT）。本荟萃分析旨在阐明新辅助和确定性治疗OSCC.Methods的好处：合格的随机对照试验（RCT）确定使用科克伦数据库，MEDLINE和Embase。只有随机对照试验与意向治疗分析，并公布的风险比（HR）或估计从生存data.Results：九个随机对照试验涉及新辅助CRT与手术，八个涉及新辅助化疗与手术，三个涉及新辅助治疗，然后手术或手术单独与dCRT。新辅助CRT后总生存率的HR为0.81（95%置信区间0.70 - 0.95; P = 0.008），新辅助化疗后为0.93（0.81 - 1.08; P = 0.368）。新辅助治疗后R 0切除的可能性显著更高（CRT：HR 1.15，P = 0.043;化疗：HR 1.16，P = 0.006）。新辅助CRT后的死亡率未增加（HR 0.94，P = 0.363），但联合治疗的30天死亡率无显著性升高。新辅助化疗和手术后的发病率（HR 1.03，P = 0.638）和死亡率（HR 1.04，P = 0.810）与单纯手术后的发病率和死亡率无差异。没有一个随机对照试验报告结果后dCRT表现出显着的生存效益，但治疗相关的死亡率较低（HR 7.60，P = 0.007）比新辅助治疗后手术或手术单独。结论：对于可切除的口腔鳞癌患者，新辅助CRT的生存效益是显而易见的，发病率没有增加。dCRT与其他治疗策略相比未显示出任何生存获益。
Background: The standard treatment for resectable oesophageal squamous cell carcinoma (OSCC) is surgical resection with adequate lymphadenectomy. Most Western patients receive neoadjuvant chemotherapy or chemoradiotherapy (CRT). In recent years some patients have received CRT alone (definitive CRT, dCRT). This meta-analysis sought to clarify the benefits of neoadjuvant and definitive treatment for OSCC.Methods: Eligible randomized controlled trials (RCTs) were identified using the Cochrane database, MEDLINE and Embase. Only RCTs with intention-to-treat analysis, and published hazard ratios (HRs) or estimates from survival data, were included.Results: Nine RCTs involving neoadjuvant CRT versus surgery, eight involving neoadjuvant chemotherapy versus surgery, and three involving neoadjuvant treatment followed by surgery or surgery alone versus dCRT were identified. The HR for overall survival was 0.81 (95 per cent confidence interval 0.70 to 0.95; P = 0.008) after neoadjuvant CRT and 0.93 (0.81 to 1.08; P = 0.368) after neoadjuvant chemotherapy. The likelihood of R0 resection was significantly higher after neoadjuvant treatment (CRT: HR 1.15, P = 0.043; chemotherapy: HR 1.16, P = 0.006). Morbidity rates were not increased after neoadjuvant CRT (HR 0.94, P = 0.363) but 30-day mortality was non-significantly higher with combined treatment. Morbidity (HR 1.03, P = 0.638) and mortality (HR 1.04, P = 0.810) rates after neoadjuvant chemotherapy and surgery did not differ from those after surgery alone. None of the RCTs reporting outcome after dCRT demonstrated a significant survival benefit, but treatment-related mortality rates were lower (HR 7.60, P = 0.007) than with neoadjuvant treatment followed by surgery or surgery alone.Conclusion: For patients with resectable OSCC, a significant survival benefit for neoadjuvant CRT was evident, with no increase in morbidity rate. dCRT did not demonstrate any survival benefit over other curative strategies.