Preoperative Chemoradiotherapy vs Chemotherapy for Adenocarcinoma of the Esophagogastric Junction: A Network Meta-Analysis.

Autor:	Ronellenfitsch U; Department of Abdominal, Vascular and Endocrine Surgery, Medical Faculty of the Martin-Luther-University Halle-Wittenberg and University Hospital Halle (Saale), Halle (Saale), Germany., Friedrichs J; Department of Abdominal, Vascular and Endocrine Surgery, Medical Faculty of the Martin-Luther-University Halle-Wittenberg and University Hospital Halle (Saale), Halle (Saale), Germany., Barbier E; Fédération Francophone de Cancérologie Digestive, Centre de Recherche Institut, Institut National de la Santé et de la Recherche Médicale, Epidemiology of Digestive Cancers, University of Burgundy, Franche-Comté, France., Bass GA; Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia., Burmeister B; Department of Radiation Oncology, GenesisCare Fraser Coast and the Hervey Bay Hospital, Urraween, Australia., Cunningham D; Institute of Cancer Research, National Institute for Health and Care Research Biomedical Research Centre, The Royal Marsden Hospital, London, United Kingdom., Eyck BM; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Grilli M; Library of the Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany., Hofheinz RD; Day Treatment Center, Interdisciplinary Tumor Center Mannheim and Third Department of Internal Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany., Kieser M; Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany., Kleeff J; Department of Abdominal, Vascular and Endocrine Surgery, Medical Faculty of the Martin-Luther-University Halle-Wittenberg and University Hospital Halle (Saale), Halle (Saale), Germany., Klevebro F; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Center for Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden., Langley R; MRC (Medical Research Council) Clinical Trials Unit, University College London, London, United Kingdom., Lordick F; Department of Oncology, University Cancer Center Leipzig and Cancer Center Central Germany, University of Leipzig Medical Center, Leipzig, Germany., Lutz M; Department of Gastroenterology, Endocrinology, and Infectiology, Caritasklinik St Theresia, Saarbrücken, Germany., Mauer M; Statistics Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium., Michalski CW; Department of General, Abdominal and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany., Michl P; Department of Gastroenterology, Infectiology and Toxicology, University Hospital Heidelberg, Heidelberg, Germany., Nankivell M; MRC (Medical Research Council) Clinical Trials Unit, University College London, London, United Kingdom., Nilsson M; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Center for Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden., Seide S; Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.; Boehringer Ingelheim, Ingelheim, Germany., Shah MA; Solid Tumor Oncology, Weill Cornell Medicine, New York, New York., Shi Q; Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota., Stahl M; Department of Medical Oncology and Hematology With Integrated Palliative Medicine, Protestant Hospital Essen-Mitte, Essen, Germany., Urba S; Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor., van Lanschot J; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Vordermark D; Department of Radiotherapy, Medical Faculty of the Martin-Luther-University Halle-Wittenberg and University Hospital Halle (Saale), Halle (Saale), Germany., Walsh TN; Royal College of Surgeons in Ireland, Dublin., Ychou M; Montpellier Cancer Institute, Montpellier, France., Proctor T; Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany., Vey JA; Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Aug 01; Vol. 7 (8), pp. e2425581. Date of Electronic Publication: 2024 Aug 01.
DOI:	10.1001/jamanetworkopen.2024.25581
Abstrakt:	Importance: The prognosis of patients with adenocarcinoma of the esophagus and esophagogastric junction (AEG) is poor. From current evidence, it remains unclear to what extent preoperative chemoradiotherapy (CRT) or preoperative and/or perioperative chemotherapy achieve better outcomes than surgery alone. Objective: To assess the association of preoperative CRT and preoperative and/or perioperative chemotherapy in patients with AEG with overall survival and other outcomes. Data Sources: Literature search in PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and International Clinical Trials Registry Platform was performed from inception to April 21, 2023. Study Selection: Two blinded reviewers screened for randomized clinical trials comparing preoperative CRT plus surgery with preoperative and/or perioperative chemotherapy plus surgery, 1 intervention with surgery alone, or all 3 treatments. Only data from participants with AEG were included from trials that encompassed mixed histology or gastric cancer. Among 2768 initially identified studies, 17 (0.6%) met the selection criteria. Data Extraction and Synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed for extracting data and assessing data quality by 2 independent extractors. A bayesian network meta-analysis was conducted using the 2-stage approach. Main Outcomes and Measures: Overall and disease-free survival, postoperative morbidity, and mortality. Results: The analyses included 2549 patients (2206 [86.5%] male; mean [SD] age, 61.0 [9.4] years) from 17 trials (conducted from 1989-2016). Both preoperative CRT plus surgery (hazard ratio [HR], 0.75 [95% credible interval (CrI), 0.62-0.90]; 3-year difference, 105 deaths per 1000 patients) and preoperative and/or perioperative chemotherapy plus surgery (HR, 0.78 [95% CrI, 0.64-0.91]; 3-year difference, 90 deaths per 1000 patients) showed longer overall survival than surgery alone. Comparing the 2 modalities yielded similar overall survival (HR, 1.04 [95% CrI], 0.83-1.28]; 3-year difference, 15 deaths per 1000 patients fewer for CRT). Similarly, disease-free survival was longer for both modalities compared with surgery alone. Postoperative morbidity was more frequent after CRT plus surgery (odds ratio [OR], 2.94 [95% CrI, 1.01-8.59]) than surgery alone. Postoperative mortality was not significantly more frequent after CRT plus surgery than surgery alone (OR, 2.50 [95% CrI, 0.66-10.56]) or after chemotherapy plus surgery than CRT plus surgery (OR, 0.44 [95% CrI, 0.08-2.00]). Conclusions and Relevance: In this meta-analysis of patients with AEG, both preoperative CRT and preoperative and/or perioperative chemotherapy were associated with longer survival without relevant differences between the 2 modalities. Thus, either of the 2 treatments may be recommended to patients.
Databáze:	MEDLINE
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