Individual Participant Data Network Meta-Analysis of Neoadjuvant Chemotherapy or Chemoradiotherapy in Esophageal or Gastroesophageal Junction Carcinoma.

Autor:	Faron M; Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France., Cheugoua-Zanetsie M; Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France., Tierney J; MRC Clinical Trial Unit at UCL, London, United Kingdom., Thirion P; St Luke Hospital, Dublin, Ireland., Nankivell M; MRC Clinical Trial Unit at UCL, London, United Kingdom., Winter K; NRG Oncology Statistics and Data Management Center, Philadelphia, PA., Yang H; Sun Yat-Sen University Cancer Center, Guangzhou, China., Shapiro J; Erasmus University Medical Center, Rotterdam, the Netherlands., Vernerey D; CHRU Jean Minjoz, Besançon, France., Smithers BM; University of Queensland, Princess Alexandra Hospital, Brisbane, Australia., Walsh T; Connolly Hospital Blanchardstown, Dublin, Ireland., Piessen G; CHU de Lille, Lille, France., Nilsson M; Division of Surgery, Department of Clinical Science, Intervention and Technoglogy, Karolinska Institutet, Stockholm, Sweden.; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden., Boonstra J; Leiden University Medical Center, Leiden, the Netherlands., Ychou M; Val d'Aurelles, Montpellier, France., Law S; Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China., Cunningham D; National Institute for Health Research, Biomedical Research Centres, Royal Marsden, London, United Kingdom., de Vathaire F; Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France., Stahl M; Evang. Kliniken Essen-Mitte, Essen, Germany., Urba S; University of Michigan, Ann Arbor, MI., Valmasoni M; Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Center for Esophageal Diseases, Padova, Italy., Williaume D; Centre Eugène Marquis, Rennes, France., Thomas J; Princess Alexandra Hospital, Woolloongabba, Australia., Lordick F; University of Leipzig, Leipzig, Germany., Tepper J; University of North Carolina School of Medicine, Chapel Hill, NC., Roth J; MD Anderson, Houston, TX., Gebski V; NHMRC, Sydney, Australia., Burmeister B; Princess Alexandra Hospital, Woolloongabba, Australia., Paoletti X; Institut Curie, Paris, France., van Sandick J; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands., Fu J; Sun Yat-Sen University Cancer Center, Guangzhou, China., Pignon JP; Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France., Ducreux M; Departement d'Oncologie Médicale, Gustave Roussy, Villejuif, France., Michiels S; Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2023 Oct 01; Vol. 41 (28), pp. 4535-4547. Date of Electronic Publication: 2023 Jul 12.
DOI:	10.1200/JCO.22.02279
Abstrakt:	Purpose: The optimal neoadjuvant treatment for resectable carcinoma of the thoracic esophagus (TE) or gastroesophageal junction (GEJ) remains a matter of debate. We performed an individual participant data (IPD) network meta-analysis (NMA) of randomized controlled trials (RCTs) to study the effect of chemotherapy or chemoradiotherapy, with a focus on tumor location and histology subgroups. Patients and Methods: All, published or unpublished, RCTs closed to accrual before December 31, 2015 and having compared at least two of the following strategies were eligible: upfront surgery (S), chemotherapy followed by surgery (CS), and chemoradiotherapy followed by surgery (CRS). All analyses were conducted on IPD obtained from investigators. The primary end point was overall survival (OS). The IPD-NMA was analyzed by a one-step mixed-effect Cox model adjusted for age, sex, tumor location, and histology. The NMA was registered in PROSPERO (CRD42018107158). Results: IPD were obtained for 26 of 35 RCTs (4,985 of 5,807 patients) corresponding to 12 comparisons for CS-S, 12 for CRS-S, and four for CRS-CS. CS and CRS led to increased OS when compared with S with hazard ratio (HR) = 0.86 (0.75 to 0.99), P = .03 and HR = 0.77 (0.68 to 0.87), P < .001 respectively. The NMA comparison of CRS versus CS for OS gave a HR of 0.90 (0.74 to 1.09), P = .27 (consistency P = .26, heterogeneity P = .0038). For CS versus S, a larger effect on OS was observed for GEJ versus TE tumors ( P = .036). For the CRS versus S and CRS versus CS, a larger effect on OS was observed for women ( P = .003, .012, respectively). Conclusion: Neoadjuvant chemotherapy and chemoradiotherapy were consistently better than S alone across histology, but with some variation in the magnitude of treatment effect by sex for CRS and tumor location for CS. A strong OS difference between CS and CRS was not identified.
Databáze:	MEDLINE
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