Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2024; 16(1): 214-233
Published online Jan 15, 2024. doi: 10.4251/wjgo.v16.i1.214
Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer: A meta-analysis
Mao-Xiu Yuan, Qi-Gui Cai, Zhen-Yang Zhang, Jian-Zhong Zhou, Cai-Yun Lan, Jiang-Bo Lin
Mao-Xiu Yuan, The Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, China
Mao-Xiu Yuan, Qi-Gui Cai, Jian-Zhong Zhou, Cai-Yun Lan, Department of Thoracic Surgery, Affiliated Hospital of Jinggangshan University, Ji’an 343000, Jiangxi Province, China
Zhen-Yang Zhang, Jiang-Bo Lin, Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, Fujian Province, China
Author contributions: Lin JB, Cai QG and Zhang ZY were responsible for research design; Zhou JZ, and Lan CY were responsible for conducting the experiments; Yuan MX, Cai QG, Zhang ZY and Lan CY were responsible for data acquisition; Yuan MX and Lin JB were responsible for data analysis; Yuan MX were responsible for writing the manuscript; All the authors have contributed to the completion of this paper.
Conflict-of-interest statement: No conflicts of interest exits in the submission of this manuscript.
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: Jiang-Bo Lin, MD, Chief Physician, Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350000, Fujian Province, China. 18779654883@163.com
Received: September 19, 2023
Peer-review started: September 19, 2023
First decision: October 9, 2023
Revised: October 20, 2023
Accepted: December 4, 2023
Article in press: December 4, 2023
Published online: January 15, 2024
Processing time: 113 Days and 22.1 Hours
Abstract
BACKGROUND

The effectiveness of neoadjuvant therapy in esophageal cancer (EC) treatment is still a subject of debate.

AIM

To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) for locally advanced EC (LAEC).

METHODS

A comprehensive search was conducted using multiple databases, including PubMed, EMBASE, MEDLINE, Science Direct, The Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Journal Database, and Chinese Biomedical Literature Database Article. Studies up to December 2022 comparing nCRT and nCT in patients with EC were selected.

RESULTS

The analysis revealed significant differences between nCRT and nCT in terms of disease-free survival. The results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate (OSR) [odds ratio (OR) = 0.95], complete response rate (OR = 3.15), and R0 clearance rate (CR) (OR = 2.25). However, nCT demonstrated a better 5-year OSR (OR = 1.02) than nCRT. Moreover, when compared to nCRT, nCT showed reduced risks of cardiac complications (OR = 1.15) and pulmonary complications (OR = 1.30).

CONCLUSION

Overall, both nCRT and nCT were effective in terms of survival outcomes for LAEC. However, nCT exhibited better performance in terms of postoperative complications.

Keywords: Esophageal cancer; Neoadjuvant chemoradiotherapy; Radical resection for esophageal cancer; Neoadjuvant chemotherapy; Meta-analysis

Core Tip: Neoadjuvant chemoradiotherapy (nCRT) significantly improves the overall survival rate, pathological complete response rate, and R0 clearance rate for esophageal cancer. However, neoadjuvant chemotherapy (nCT) offers advantages in reducing postoperative cardiopulmonary complications and perioperative mortality. Esophageal squamous cell carcinoma patients benefit more from nCRT in terms of survival rates. The choice between nCRT and nCT should consider the patient's individual conditions and sensitivity to radiotherapy and chemotherapy. Careful consideration is necessary to achieve optimal long-term survival outcomes while minimizing complications.