Survival After Neoadjuvant and Adjuvant Treatments Compared to Surgery Alone for Resectable Esophageal Carcinoma A Network Meta-analysis
Survival After Neoadjuvant and Adjuvant Treatments Compared to Surgery Alone for Resectable Esophageal Carcinoma A Network Meta-analysis
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DOI：
10.1097/sla.0000000000001905
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发表时间：
2017-03-01
影响因子：
9
通讯作者：
Griffiths, Ewen A.
中科院分区：
文献类型：
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作者：
Pasquali, Sandro;Yim, Guang;Griffiths, Ewen A.
目的：本网络荟萃分析比较了新辅助或辅助化疗（CT），放疗（RT），或两者结合（放化疗，CRT）或手术后的总生存率，以确定最有效的approach.Summary背景数据：可切除食管癌的最佳治疗方法是未知的。使用网络荟萃分析，治疗根据其改善生存的有效性进行排名。结果：在33项符合条件的随机对照试验中，6072名患者被随机分为两组，（N = 2459）或新辅助CT（N = 1332）、RT（N = 58）和CRT（N = 1196），然后进行手术或手术后进行辅助CT（N = 542）、RT（N = 383）和CRT（N = 102）。共进行了21次比较。与单纯手术相比，新辅助CRT后手术是唯一显著改善生存率的治疗[风险比（HR）= 0.77，95%置信区间（CI）：0.68-0.87]。当考虑新辅助治疗和辅助治疗以及单独手术对试验进行分组时，与单独手术相比，新辅助治疗联合手术显示出生存优势（HR = 0.83，95% CI 0.76-0.90），而手术沿着辅助治疗显示无显著生存优势（HR = 0.87，95% CI 0.67-1.14）。新辅助治疗的亚组分析显示，新辅助CRT和手术的上级有效性优于单纯手术（HR = 0.77，95%CI 0.68-0.87）。结论：该网络荟萃分析显示，新辅助CRT后手术是提高可切除食管癌生存率的最有效策略。资源应集中在开发最有效的新辅助CRT方案的腺癌和鳞状细胞癌的食管。
Objective: This network meta-analysis compared overall survival after neo-adjuvant or adjuvant chemotherapy (CT), radiotherapy (RT), or combinations of both (chemoradiotherapy, CRT) or surgery alone to identify the most effective approach.Summary Background Data: The optimal treatment for resectable esophageal cancer is unknown.Methods: A search for randomized controlled trials reporting on neoadjuvant and adjuvant therapies was conducted. Using a network meta-analysis, treatments were ranked based on their effectiveness for improving survival.Results: In 33 eligible randomized controlled trials, 6072 patients were randomized to receive either surgery alone (N = 2459) or neoadjuvant CT (N = 1332), RT (N = 58), and CRT (N = 1196) followed by surgery or surgery followed by adjuvant CT (N = 542), RT (N = 383), and CRT (N = 102). Twenty-one comparisons were generated. Neoadjuvant CRT followed by surgery compared with surgery alone was the only treatment to significantly improve survival [hazard ratio (HR) = 0.77, 95% confidence interval (CI): 0.68-0.87]. When trials were grouped considering neoadjuvant and adjuvant therapies and surgery alone, neoadjuvant therapies combined with surgery compared with surgery alone showed a survival advantage (HR = 0.83, 95% CI 0.76-0.90), whereas surgery along with adjuvant therapies showed no significant survival advantage (HR = 0.87, 95% CI 0.67-1.14). A subgroup analysis of neoadjuvant therapies showed a superior effectiveness of neoadjuvant CRT and surgery compared with surgery alone (HR = 0.77, 95% CI 0.68-0.87).Conclusions: This network meta-analysis showed neoadjuvant CRT followed by surgery to be the most effective strategy in improving survival of resectable esophageal cancer. Resources should be focused on developing the most effective neoadjuvant CRT regimens for both adenocarcinomas and squamous cell carcinomas of the esophagus.