Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis
Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis
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DOI：
10.1016/s1470-2045(07)70039-6
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发表时间：
2007-03-01
期刊：
影响因子：
51.1
通讯作者：
Simes, John
中科院分区：
文献类型：
--
作者：
Gebski, Val;Burmeister, Bryan;Simes, John
背景：可切除食管癌的治疗通常是单独手术或术前（新辅助）放化疗或化疗。我们旨在通过随机试验数据的荟萃分析来阐明新辅助放化疗或化疗与单独手术的益处。方法首先从早期发表的荟萃分析和系统评价中确定符合条件的试验。我们还使用MEDLINE、Cancerlit和EMBASE数据库来确定自1980年以来主要科学会议的其他研究和已发表的摘要。仅纳入了根据意向治疗原则进行分析的随机研究，并且搜索仅限于引用英文文章的数据库。我们使用已公布的风险比（如果可用）或其他生存数据或生存曲线的估计。按肿瘤类型和治疗顺序对治疗效果进行了研究。研究发现，在局部可手术食管癌患者中，新辅助放化疗与单纯手术的随机比较有10例（n=1209），新辅助化疗与单纯手术的随机比较有8例（n=1724）。新辅助放化疗与单纯手术的全因死亡率风险比为0.81 (95% CI 0.70-0.93; p=0.002)，对应于2年生存率的13%的绝对差异，不同组织学肿瘤类型的结果相似：鳞状细胞癌（SCC）为0.84 (0.71-0.99;p=0.04)，腺癌为0.75 （0.59-0.95;p=0.02）。新辅助化疗的风险比为0.90 (0.81-1.00;p=0.05)， 2年绝对生存获益为7%。化疗对SCC患者的全因死亡率无显著影响（风险比0.88 [0.75-1.03];p=0.12），但对腺癌患者有显著益处（风险比0.78 [0.64-0.95];p=0.014）。术前放化疗对食管癌患者的生存有明显的好处，而化疗对食管癌患者的生存有较小的好处。研究结果为在管理决策中使用新辅助治疗提供了一个基于证据的框架。
Background Resectable oesophageal cancer is often treated with surgery alone or with preoperative (neoadjuvant) chemoradiotherapy or chemotherapy. We aimed to clarify the benefits of neoadjuvant chemoradiotherapy or chemotherapy versus surgery alone by a meta-analysis of randomised trial data.Methods Eligible trials were identified first from earlier published meta-analyses and systematic reviews. We also used MEDLINE, Cancerlit, and EMBASE databases to identify additional studies and published abstracts from major scientific meetings since 1980. Only randomised studies with an analysis by an intention-to-treat principle were included, and searches were restricted to those databases citing articles in English. We used published hazard ratios if available or estimates from other survival data or survival curves. Treatment effects by type of tumour and treatment sequencing were also investigated.Findings Ten randomised comparisons of neoadjuvant chemoradiotherapy versus surgery alone (n=1209) and eight of neoadjuvant chemotherapy versus surgery alone (n=1724) in patients with local operable oesophageal carcinoma were identified. The hazard ratio for all-cause mortality with neoadjuvant chemoradiotherapy versus surgery alone was 0.81 (95% CI 0.70-0.93; p=0.002), corresponding to a 13% absolute difference in survival at 2 years, with similar results for different histological tumour types: 0.84 (0.71-0.99; p=0.04) for squamous-cell carcinoma (SCC), and 0.75 (0.59-0.95; p=0.02) for adenocarcinoma. The hazard ratio for neoadjuvant chemotherapy was 0.90 (0.81-1.00; p=0.05), which indicates a 2-year absolute survival benefit of 7%. There was no significant effect on all-cause mortality of chemotherapy for patients with SCC (hazard ratio 0.88 [0.75-1.03]; p=0.12), although there was a significant benefit for those with adenocarcinoma (0.78 [0.64-0.95]; p=0.014).Interpretation A significant survival benefit was evident for preoperative chemoradiotherapy and, to a lesser extent, for chemotherapy in patients with adenocarcinoma of the oesophagus. The findings provide an evidence-based framework for the use of neoadjuvant treatment in management decisions.