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
Processing time: 88 Days and 15.2 Hours
ARTICLE HIGHLIGHTS
Research background

The incidence of adenocarcinoma (AC) in the esophagus is increasing, especially in the Western countries, in contrast to the incidence of squamous cell carcinomas (SCC). Neoadjuvant therapy before surgery can improve patient survival in advanced stages. The superiority of neoadjuvant modalities, especially for ACs, remains unclear. Previous meta-analyses have numerous limitations, including the pooled populations of AC and SCC, which makes the application of their results specifically to either subtype difficult.

Research motivation

The superiority of neoadjuvant therapy has been proven previously; however, determining which modality has a greater benefit, especially for esophageal AC, remains uncertain. In this study, we performed a comprehensive, up-to-date investigation to compare the efficacy of neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) in the surgical treatment of AC of the esophagus and esophageal junction.

Research objectives

To address the questions of this meta-analysis, we used the PICO protocol to evaluate data from patients with esophageal or cardiac AC, who underwent neoadjuvant therapy before surgery. Intervention was preoperative nCT, which was compared with nCRT. We investigated the following outcomes: Survival, remission rate, mortality, short- and long-term clinical and surgical complications, and quality of life.

Research methods

Following the PICO protocol, two authors independently performed a comprehensive search of multiple databases using the predefined criteria. Statistical analyses were performed by biostatisticians to calculate odds ratio and hazard ratio with the 95%CI. Results were visualized using forest plots and Kaplan-Meier curves. The Risk of Bias Tool 2 and GRADE approach were used to assess the quality of the results.

Research results

Ten articles were included after selection. After statistical analysis, we observed that 30-d mortality (P = 0.015) and pathological complete response (P < 0.001) were higher in the nCRT group than in the nCT group; however, no significant difference was observed for long-term survival. The risk of renal failure (P = 0.039) was higher in the nCT group, and the incidence of nausea or vomiting was 9% in the nCT group compared to 3% in the nCRT group. No significant difference was reported in other clinical or surgical complications.

Research conclusions

Although the superiority of neoadjuvant therapy has been previously demonstrated, nCRT may increase pathological complete response and 30-d mortality, without improving long-term survival. Furthermore, nCT may lead to some adverse effects, which can decrease the quality of life.

Research perspectives

The present study predominantly analyzed retrospective data, potentially introducing research bias; therefore, future randomized studies with more detailed data collection are warranted.