Comparison of different neoadjuvant treatments for resectable locoregional esophageal cancer: A systematic review and network meta‐analysis

Autor: Yongxing Bao, Zeliang Ma, Meng Yuan, Yang Wang, Yu Men, Zhouguang Hui
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Thoracic Cancer, Vol 13, Iss 17, Pp 2515-2523 (2022)
Druh dokumentu: article
ISSN: 1759-7714
1759-7706
DOI: 10.1111/1759-7714.14588
Popis: Abstract Purpose The best pattern of neoadjuvant therapy for resectable locoregional esophageal cancer has not been determined. Our study evaluated the efficacy and postoperative events of different treatments using the Bayesian network meta‐analysis. Methods We systematically tracked randomized clinical trials from the Medline, EMBASE, and Cochrane Library databases. The following treatments were included: neoadjuvant chemoradiation followed by surgery (NCRT + S), neoadjuvant chemotherapy followed by surgery (NCT + S), neoadjuvant radiotherapy followed by surgery (NRT + S), and surgery alone (S). The Revised Cochrane risk‐of‐bias tools were used to assess the quality of included trials. Overall survival (OS) and progression‐free survival or disease‐free survival (PFS/DFS) were assessed through hazard ratios (HR). Locoregional recurrence, distant metastasis, postoperative mortality, and postoperative morbidity were assessed through odds ratios (OR). These outcomes were compared between different treatments through Bayesian network meta‐analysis. Results Twenty trials with 4384 patients were included. Compared with S, only NCRT + S could significantly improve OS for patients with esophageal cancer (HR = 0.78, 95% confidence interval [CI] 0.68–0.88). NCRT + S and NCT + S significantly improved PFS/DFS compared with S (NCRT + S vs. S, HR = 0.72, 95% CI 0.63–0.81; NCT + S vs. S, HR = 0.81, 95% CI 0.69–0.97). NCRT + S significantly reduced both locoregional recurrence (OR = 0.67, 95% CI 0.51–0.88) and distant metastasis (OR = 0.63, 95% CI 0.45–0.90) compared with S. There were no differences in postoperative morbidity between the four treatments. However, NCRT + S also increased postoperative mortality compared with S (OR = 1.77, 95% CI 1.09–2.82) and NCT + S (OR = 1.96, 95% CI 1.11–3.51). Conclusion NCRT + S is the most efficient neoadjuvant treatment for resectable locoregional esophageal cancer. However, NCRT + S increases the risk of postoperative mortality but not morbidity.
Databáze: Directory of Open Access Journals
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