Meta-analysis Of Neoadjuvant And Postoperative Chemoradiotherapy For Resectable Esophageal Cancer

OBJECTIVE:At present,the incidence and mortality of esophageal cancer patients in China are on the rise,and the effectiveness of simple surgery is not satisfactory.Therefore,this study uses systematic evaluation method to analyze the survival benefit of neoadjuvant chemoradiotherapy combined with postoperative chemoradiotherapy for resectable esophageal cancer.The outcome provides a theoretical basis for guiding the choice of clinical treatment of esophageal cancer.In China,the incidence and mortality of esophageal cancer patients are on the rise,and the efficacy of surgery alone is not satisfactory.In this study,the systematic evaluation method was used to analyze the survival benefit of preoperative neoadjuvant chemoradiotherapy and postoperative adjuvant chemoradiotherapy for resectable esophageal cancer.To provide a theoretical basis for the choice of clinical treatment direction of esophageal cancer.METHODS:We performed systematic computerized searches of the PubMed,EMBASE,the Cochrane Library,China Biomedical Literature Database(CBM-disc),Wanfang Data Resource System,China Journal Full-text Database(CNKI),Chinese Journal of Clinical Oncology and supplemented by manual search and follow-up references reports including all clinical studies about comparing neoadjuvant chemoradiotherapy with postoperative chemoradiotherapy for esophageal cancer dated up to January 2019.The Cochrance quality evaluation criteria was used to assess the quality of the randomized controlled trial(RCT).And,Newcastle Ottawa Scale(NOS)was used to assess the quality of non-randomized controlled trials.The data were analyzed using RevMan 5.3 software.RESULTS:1 RCT trial and 8 non-randomized controlled trials were included in this study.Among them,847 cases were treated with neoadjuvant chemoradiotherapy,and 799 cases were treated with adjuvant chemoradiotherapy.All literature assessment quality were generally high.The result of meta-analysis showed that:1-year survival rate(OR=1.38,95%CI:1.06 to 1.80,P=0.02),2-years survival rate(OR=2.51,95%CI:1.57-4.01,P=0.0001),3-year survival rate(OR=1.39,95%CI:1.12 to 1.72,P=0.002)and 5-year survival rate(OR=1.54,95%CI:1.08-2.18,P=0.02)were significantly between the neoadjuvant chemoradiotherapy group and postoperative adjuvant chemoradiotherapy group.And 1-year disease-free survival(OR=1.46,95%Cl:1.07-2.00,P=0.02)was statistically significant in both groups,but 3-year disease-free survival(OR=1.35,95%CI:0.99-1.83,P=0.06)was not statistically significant.Subgroup analysis showed a 1-year survival rate(OR=1.43,95%CI:1.02-1.99,P=0.04)was statistically significant in the preoperative and postoperative groups of patients with esophageal squamous cell carcinoma,with a 3-year survival rate(OR=1.20,95%CI:0.91-1.57,P=0.19)was not statistical significance.CONCLUSION:1.Compared with postoperative adjuvant chemoradiotherapy,neoadjuvant therapy for esophageal cancer has a higher survival benefit in 1-year,3-year,5-year survival rate and 1-year disease-free survival rate.In terms of 3-year disease-free survival,however,the efficacy was similar.2.Subgroup comparison of esophageal squamous cell carcinoma suggested that the neoadjuvant group could improve 1-year survival rate,but did not gain an advantage in 3-year survival rate.