Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2024; 30(11): 1621-1635
Published online Mar 21, 2024. doi: 10.3748/wjg.v30.i11.1621
Effects of neoadjuvant chemotherapy vs chemoradiotherapy in the treatment of esophageal adenocarcinoma: A systematic review and meta-analysis
Armand Csontos, Alíz Fazekas, Lajos Szakó, Nelli Farkas, Csenge Papp, Szilárd Ferenczi, Szabolcs Bellyei, Péter Hegyi, András Papp
Armand Csontos, Csenge Papp, Szilárd Ferenczi, András Papp, Department of Surgery, University of Pécs, Medical School, Clinical Center, Pécs H-7624, Baranya, Hungary
Alíz Fazekas, Nelli Farkas, Institute of Bioanalysis, University of Pécs, Medical School, Pécs H-7624, Baranya, Hungary
Alíz Fazekas, Nelli Farkas, Péter Hegyi, Institute for Translational Medicine, University of Pécs, Medical School, Pécs H-7624, Baranya, Hungary
Lajos Szakó, Department of Emergency Medicine, Clinical Center, University of Pécs, Medical School, Pécs 7624, Baranya, Hungary
Szabolcs Bellyei, Department of Oncotherapy, University of Pécs, Medical School, Clinical Center, Pécs H-7624, Baranya, Hungary
Péter Hegyi, Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
Péter Hegyi, Institute of Pancreatic Diseases, Semmelweis University, Budapest H-1083, Hungary
Author contributions: Csontos A contributed to the design and implementation of the study and the writing of the manuscript; Fazekas A and Farkas N contributed to the statistical analyses and the writing of the manuscript; Szakó L contributed to the design of the study and the revision of the manuscript; Papp C and Ferenczi S contributed to the performance of the research; Bellyei S and Hegyi P contributed to the quality and professional revision; Papp A contributed to the quality and professional revision and the writing of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Armand Csontos, MD, Doctor, Department of Surgery, University of Pécs, Medical School, Clinical Center, Ifjúság Street 13, Pécs H-7624, Baranya, Hungary. csontos.armand@gmail.com
Received: December 23, 2023
Peer-review started: December 23, 2023
First decision: January 4, 2024
Revised: January 18, 2024
Accepted: March 4, 2024
Article in press: March 4, 2024
Published online: March 21, 2024
Abstract
BACKGROUND

Neoadjuvant therapy is an essential modality for reducing the clinical stage of esophageal cancer; however, the superiority of neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT) is unclear. Therefore, a discussion of these two modalities is necessary.

AIM

To investigate the benefits and complications of neoadjuvant modalities.

METHODS

To address this concern, predefined criteria were established using the PICO protocol. Two independent authors performed comprehensive searches using predetermined keywords. Statistical analyses were performed to identify significant differences between groups. Potential publication bias was visualized using funnel plots. The quality of the data was evaluated using the Risk of Bias Tool 2 (RoB2) and the GRADE approach.

RESULTS

Ten articles, including 1928 patients, were included for the analysis. Significant difference was detected in pathological complete response (pCR) [P < 0.001; odds ratio (OR): 0.27; 95%CI: 0.16-0.46], 30-d mortality (P = 0.015; OR: 0.4; 95%CI: 0.22-0.71) favoring the nCRT, and renal failure (P = 0.039; OR: 1.04; 95%CI: 0.66-1.64) favoring the nCT. No significant differences were observed in terms of survival, local or distal recurrence, or other clinical or surgical complications. The result of RoB2 was moderate, and that of the GRADE approach was low or very low in almost all cases.

CONCLUSION

Although nCRT may have a higher pCR rate, it does not translate to greater long-term survival. Moreover, nCRT is associated with higher 30-d mortality, although the specific cause for postoperative complications could not be identified. In the case of nCT, toxic side effects are suspected, which can reduce the quality of life. Given the quality of available studies, further randomized trials are required.

Keywords: Neoadjuvant, Chemotherapy, Chemoradiotherapy, Esophageal cancer, Adenocarcinoma

Core Tip: Neoadjuvant chemoradiation increases pathological complete response and 30-d mortality in patients with esophageal adenocarcinoma; however, it has no effect on long-term survival. It may be associated with side effects that can reduce the quality of life.