Clinical significance of neoadjuvant therapy in patients with cT2N0 esophageal cancer: a meta-analysis

doi:10.3877/cma.j.issn.2095-8773.2021.04.08

Abstract

Abstract:

Objective

To evaluate the clinical significance of NS in patients with cT2N0 resectable esophageal cancer.

Methods

Real-world studies were identified by searching databases including PubMed, Web of Science, EMBASE, Cochrane Library and China National Knowledge Infrastructure (CNKI). Data on 5-year overall survival, pathological upstaging and downstaging, margin positive rate and anastomotic leakage were extracted to assess the pros and cons of NS. The meta-analysis was performed using RevMan 5.4 and R version 4.0.2.

Results

A total of 4 602 patients from 7 real-world studies were included. The pooled results suggested that there were no significant differences in the 5-year overall survival and recurrence free survival between neoadjuvant plus surgery (NS) group and surgery alone (S) group. The pooled evidence also indicated that the NS group shared similar risk of postoperative anastomotic leakage and pathological upstaging to the S group. However, the NS group exhibited its value in pathological downstaging and reduced positive margin compared with the S group (P<0.05) .

Conclusion

This study indicates that NS is not significantly associated with better long-term survival and higher probability of anastomotic leakage or pathological upstaging compared with S, but NS exhibits significant advantages in pathological downstaging as well as margin positive rate. It is recommended that upfront surgery should be considered for patients receiving thorough preoperative examinations whose gastroscopy-based pathology reports reveal no major risk factors.

Key words: Neoadjuvant therapy, Esophageal cancer, cT2N0, Meta-analysis

Peidong Song, Donglai Chen, Yuhang Xue, Wei Wang, Yongbing Chen, Yonghua Sang, Wentao Yang. Clinical significance of neoadjuvant therapy in patients with cT2N0 esophageal cancer: a meta-analysis[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(04): 247-256.

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References 30

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序号	作者（年份）	地区	病例时间范围	研究类型	样本量（人）		病理类型（%）		随访时间（月）	数据来源	新辅助治疗策略	AJCC分期版本	NOS评分	新辅助后最终病理分期（%）
序号	作者（年份）	地区	病例时间范围	研究类型	新辅助联合组	单纯手术组	腺癌	鳞癌	随访时间（月）	数据来源	新辅助治疗策略	AJCC分期版本	NOS评分	<T2N0	T2N0	>T2N0
1	Zhang等，2012^[15]	美国	1989—2009	回顾性研究	55	14	78.3	21.7	未报道	约翰霍普金斯医院	5-FU+铂类+放射	第6版	8	10.9	0	89.1
2	Markar等，2015^[16]	欧洲地区	2000—2010	回顾性研究	70	285	48.2	51.8	平均54	多个中心	化疗或放化疗结合	第7版	9	32.9	31.4	35.7
3	Capovilla等，2021^[12]	意大利	1990—2019	回顾性研究	38	191	41.9	58.1	中位30	帕多瓦大学	放化疗结合	第8版	8	47.4	23.7	28.9
4	Rhodin等，2021^[17]	美国	2004—2015	回顾性研究	1226	1177	80.8	19.2	未报道	NCDB	化疗或放化疗结合	未报道	8	未报道	未报道	未报道
5	Crabtree等，2013^[18]	美国	2002—2011	回顾性研究	270	482	未报道	未报道	未报道	STS	化疗或放化疗结合	第7版	8	31.1	30.8	38.1
6	Dolan等，2016^[19]	美国	1999—2011	回顾性研究	11	16	92.6	7.4	平均48	俄勒冈健康与科学大学	5-FU+铂类+放射	第7版	8	54.5	9.2	36.3
7	ECSGPC，2019^[20]	欧美地区	2002—2012	回顾性研究	268	499	87.7	12.3	中位30	多个中心	化疗或放化疗结合	第7版	9	45.1	20.9	34.0

序号	作者（年份）	地区	病例时间范围	研究类型	样本量（人）		病理类型（%）		随访时间（月）	数据来源	新辅助治疗策略	AJCC分期版本	NOS评分	新辅助后最终病理分期（%）
序号	作者（年份）	地区	病例时间范围	研究类型	新辅助联合组	单纯手术组	腺癌	鳞癌	随访时间（月）	数据来源	新辅助治疗策略	AJCC分期版本	NOS评分	<T2N0	T2N0	>T2N0
1	Zhang等，2012^[15]	美国	1989—2009	回顾性研究	55	14	78.3	21.7	未报道	约翰霍普金斯医院	5-FU+铂类+放射	第6版	8	10.9	0	89.1
2	Markar等，2015^[16]	欧洲地区	2000—2010	回顾性研究	70	285	48.2	51.8	平均54	多个中心	化疗或放化疗结合	第7版	9	32.9	31.4	35.7
3	Capovilla等，2021^[12]	意大利	1990—2019	回顾性研究	38	191	41.9	58.1	中位30	帕多瓦大学	放化疗结合	第8版	8	47.4	23.7	28.9
4	Rhodin等，2021^[17]	美国	2004—2015	回顾性研究	1226	1177	80.8	19.2	未报道	NCDB	化疗或放化疗结合	未报道	8	未报道	未报道	未报道
5	Crabtree等，2013^[18]	美国	2002—2011	回顾性研究	270	482	未报道	未报道	未报道	STS	化疗或放化疗结合	第7版	8	31.1	30.8	38.1
6	Dolan等，2016^[19]	美国	1999—2011	回顾性研究	11	16	92.6	7.4	平均48	俄勒冈健康与科学大学	5-FU+铂类+放射	第7版	8	54.5	9.2	36.3
7	ECSGPC，2019^[20]	欧美地区	2002—2012	回顾性研究	268	499	87.7	12.3	中位30	多个中心	化疗或放化疗结合	第7版	9	45.1	20.9	34.0

纳入研究	随机方法	分配隐藏	盲法	不完整资料偏倚	选择性报告偏倚	利益冲突
Zhang等，2012^[15]	L	U	H	L	L	L
Markar等，2015^[16]	U	U	H	L	U	L
Capovilla等，2021^[12]	L	U	L	L	L	L
Rhodin等，2020^[17]	L	U	L	H	U	L
Crabtree等，2013^[18]	L	U	H	H	L	L
Dolan等，2016^[19]	U	U	H	L	L	L
ECSGPC，2018^[20]	L	U	L	H	U	L

纳入研究	随机方法	分配隐藏	盲法	不完整资料偏倚	选择性报告偏倚	利益冲突
Zhang等，2012^[15]	L	U	H	L	L	L
Markar等，2015^[16]	U	U	H	L	U	L
Capovilla等，2021^[12]	L	U	L	L	L	L
Rhodin等，2020^[17]	L	U	L	H	U	L
Crabtree等，2013^[18]	L	U	H	H	L	L
Dolan等，2016^[19]	U	U	H	L	L	L
ECSGPC，2018^[20]	L	U	L	H	U	L

参数		研究数量（N＝6）	关联检验			异质性检验
参数		研究数量（N＝6）	OR	95%CI	P	I²（%）	P
发表年份
	≥2016（近5年）	3	1.44	1.10~1.89	<0.01	84	<0.01
	<2016	3	1.51	1.14~2.00	<0.01	48	0.15
地区
	美国	3	1.26	0.92~1.73	0.15	5	0.35
	欧洲或欧美地区	3	1.52	1.19~1.95	<0.01	85	<0.01
病理类型
	腺癌	—	1.91	1.56~5.49	0.04	77	0.13
	鳞癌	—	2.11	1.19~3.72	0.01	78	0.03
AJCC分期版本
	6	1	3.80	0.95~15.14	0.06	—	—
	7	4	1.34	1.08~1.66	<0.01	5	0.37
	8	1	5.03	2.38~10.64	<0.01	—	—

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