Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2020; 12(6): 687-698
Published online Jun 15, 2020. doi: 10.4251/wjgo.v12.i6.687
Timing of surgery after neoadjuvant chemoradiotherapy affects oncologic outcomes in patients with esophageal cancer
Qi-Xin Shang, Yu-Shang Yang, Yi-Min Gu, Xiao-Xi Zeng, Han-Lu Zhang, Wei-Peng Hu, Wen-Ping Wang, Long-Qi Chen, Yong Yuan
Qi-Xin Shang, Yu-Shang Yang, Yi-Min Gu, Han-Lu Zhang, Wei-Peng Hu, Wen-Ping Wang, Long-Qi Chen, Yong Yuan, Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Xiao-Xi Zeng, West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Shang QX, Chen LQ and Yuan Y designed research; Shang QX, Yang YS, Gu YM, and Zhang HL performed research; Zeng XX and Hu WP contributed new reagents or analytic tools; Shang QX, Gu YM and Wang WP analyzed data; Shang QX wrote the paper; all authors approved the final version; Shang QX and Yang YS contributed equally to this work.
Supported by the National Natural Science Foundation of China, No. 81970481; Sichuan Science and Technology Program, No. 2018HH0150 and Chengdu Science and Technology Bureau, No. 2016GH0200020HZ.
Conflict-of-interest statement: The authors deny any conflict of interest.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong Yuan, MD, PhD, Associate Professor, Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. yongyuan@scu.edu.cn
Received: January 23, 2020
Peer-review started: January 23, 2020
First decision: March 24, 2020
Revised: April 9, 2020
Accepted: April 28, 2020
Article in press: April 28, 2020
Published online: June 15, 2020
Processing time: 144 Days and 8 Hours
Abstract
BACKGROUND

The optimal time interval between neoadjuvant chemoradiotherapy (nCRT) and esophagectomy in esophageal cancer has not been defined.

AIM

To evaluate whether a prolonged time interval between the end of nCRT and surgery has an effect on survival outcome in esophageal cancer patients.

METHODS

We searched PubMed, Embase, Web of Science, the Cochrane Library, Wanfang and China National Knowledge Infrastructure databases for relevant articles published before November 16, 2019, to identify potential studies that evaluated the prognostic role of different time intervals between nCRT and surgery in esophageal cancer. The hazard ratios and 95% confidence intervals (95%CI) were merged to estimate the correlation between the time intervals and survival outcomes in esophageal cancer, esophageal squamous cell carcinoma and adenocarcinoma using fixed- and random-effect models.

RESULTS

This meta-analysis included 12621 patients from 16 studies. The results demonstrated that esophageal cancer patients with a prolonged time interval between the end of nCRT and surgery had significantly worse overall survival (OS) [hazard ratio (HR): 1.107, 95%CI: 1.014-1.208, P = 0.023] than those with a shorter time interval. Subgroup analysis showed that poor OS with a prolonged interval was observed based on both the sample size and HRs. There was also significant association between a prolonged time interval and decreased OS in Asian, but not Caucasian patients. In addition, a longer wait time indicated worse OS (HR: 1.385, 95%CI: 1.186-1.616, P < 0.001) in patients with adenocarcinoma.

CONCLUSION

A prolonged time interval from the completion of nCRT to surgery is associated with a significant decrease in OS. Thus, esophagectomy should be performed within 7-8 wk after nCRT.

Keywords: Esophageal cancer; Neoadjuvant chemoradiotherapy; Esophagectomy; Time interval; Survival outcome; Meta-Analysis

Core tip: Esophageal cancer is one of the most common malignant tumors worldwide. Neoadjuvant chemoradiotherapy (nCRT) is increasingly used as the standard treatment for most esophageal cancer patients. However, the optimal time interval for esophagectomy after nCRT in patients with esophageal cancer has not been defined. Therefore, we conducted a meta-analysis on 12621 patients from 16 studies to evaluate whether a prolonged time interval from the end of nCRT to surgery has an effect on survival outcome in esophageal cancer patients.