Traditional and cumulative meta‑analysis: Chemoradiotherapy followed by surgery versus surgery alone for resectable esophageal carcinoma

Feng,Haiming; Zhao,Ye; Jing,Tao; Ma,Jianxing; Zhao,Yinglu; Zhang,Jianhua; Wang,Cheng; Li,Bin

doi:10.3892/mco.2017.1534

Traditional and cumulative meta‑analysis: Chemoradiotherapy followed by surgery versus surgery alone for resectable esophageal carcinoma

Authors:
- Haiming Feng
- Ye Zhao
- Tao Jing
- Jianxing Ma
- Yinglu Zhao
- Jianhua Zhang
- Cheng Wang
- Bin Li
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Affiliations: Department of Thoracic Surgery, The Second Affiliated Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China, Evidence Based Medicine Center of Lanzhou University, Lanzhou, Gansu 730000, P.R. China, Department of Cardiac Surgery, The Second Affiliated Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China, Department of Thoracic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong 518100, P.R. China
Published online on: December 12, 2017 https://doi.org/10.3892/mco.2017.1534
Pages: 342-351

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Abstract

The role of neoadjuvant chemoradiotherapy followed by surgery (CRTS) compared with surgery alone (SA) for resectable esophageal carcinoma has been established by several randomized controlled trials (RCTs). The present study aimed to investigate the difference in survival between the two treatments by a review of meta‑analyses. Related research indicators were extracted from RCTs investigating CRTS or SA for resectable esophageal carcinoma by searching electronic databases for eligible articles. Outcomes were synthesized by adopting a fixed‑ or random‑effects model with 95% confidence interval (CI). A total of 22 RCTs including 3,419 patients were selected. The odds ratio (OR) (95% CI, P‑value), expressed as CRTS vs. SA, was 1.06 (0.94‑1.19, P=0.348) for 1‑year overall survival rate (OSR1y), 1.38 (1.20‑1.58, P<0.001) for 3‑year overall survival rate (OSR3y), and 1.42 (1.22‑1.66, P<0.001) for 5‑year overall survival rate (OSR5y). The R0 resection rate increased in patients treated by CRTS (OR=2.76, 95% CI: 2.15‑3.53, P<0.001). CRTS lowered the locoregional cancer recurrence (OR=0.49, 95% CI: 0.36‑6.65, P<0.001) and distant metastasis rate (OR=0.76, 95% CI: 0.60‑0.97, P=0.02). However, the incidence of postoperative mortality was similar between the two groups (OR=0.97, 95% CI: 0.72‑1.32, P=0.87). The subgroup analysis revealed that OSR3y and OSR5y for Asian, European and American populations were significantly higher in the CRTS group compared with those in the SA group (P<0.05). When comparing the OSR1y between the two groups for patients in all three continents, there was no significant difference (P>0.05). Histological subgroup analysis indicated that patients with esophageal adenocarcinoma may benefit from CRTS in terms of OSR1y (OR=1.55, 95% CI: 1.09‑2.20, P=0.01), OSR3y (OR=1.77, 95% CI: 1.34‑2.36, P<0.0001) and OSR5y (OR=1.92, 95% CI: 1.34‑2.75, P=0.0004). The pooled OR of squamous cell carcinoma in terms of OSR3y and OSR5y between the two groups was 1.57 (95% CI: 1.21‑2.04, P=0.0006) and 1.69 (95% CI: 1.32‑2.16, P<0.0001), respectively, but there was no statistical difference in terms of OSR1y (OR=1.13, 95% CI: 0.88‑1.45, P=0.35). Thus, neoadjuvant CRT followed by surgery may improve long‑term survival and surgical parameters, and reduce locoregional cancer recurrence and distant metastasis.

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1	Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 127:2893–2917. 2010. View Article : Google Scholar : PubMed/NCBI
2	Parkin DM, Bray FI and Devesa SS: Cancer burden in the year 2000. The global picture. Eur J Cancer. 37 Suppl 8:S4–S66. 2001. View Article : Google Scholar : PubMed/NCBI
3	Siegel RL, Miller KD and Jemal A: Cancer statistics, 2016. CA Cancer J Clin. 66:7–30. 2016. View Article : Google Scholar : PubMed/NCBI
4	Devesa SS, Blot WJ and Fraumeni JF Jr: Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 83:2049–2053. 1998. View Article : Google Scholar : PubMed/NCBI
5	Song Y, Li L, Ou Y, Gao Z, Li E, Li X, Zhang W, Wang J, Xu L, Zhou Y, et al: Identification of genomic alterations in oesophageal squamous cell cancer. Nature. 509:91–95. 2014. View Article : Google Scholar : PubMed/NCBI
6	Funk EM and Witte J: Multimodal therapy for esophageal adenocarcinoma. N Engl J Med. 336:375–376, author reply 375–376. 1997.PubMed/NCBI
7	Nygaard K, Hagen S, Hansen HS, Hatlevoll R, Hultborn R, Jakobsen A, Mäntyla M, Modig H, Munck-Wikland E, Rosengren B, et al: Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg. 16:1104–1109, discussion 1110. 1992. View Article : Google Scholar : PubMed/NCBI
8	Apinop C, Puttisak P and Preecha N: A prospective study of combined therapy in esophageal cancer. Hepatogastroenterology. 41:391–393. 1994.PubMed/NCBI
9	Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D, Boutin D, Campion JP and Launois B: A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer. 73:1779–1784. 1994. View Article : Google Scholar : PubMed/NCBI
10	Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N and Hennessy TP: A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 335:462–467. 1996. View Article : Google Scholar : PubMed/NCBI
11	Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, Lozach P, Ollier JC, Pavy JJ, Mercier M, et al: Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med. 337:161–167. 1997. View Article : Google Scholar : PubMed/NCBI
12	Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A and Strawderman M: Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 19:305–313. 2001. View Article : Google Scholar : PubMed/NCBI
13	An FS, Huang JQ, Xie YT, Chen SH and Rong TH: A prospective study of combined chemoradiotherapy followed by surgery in the treatment of esophageal carcinoma. Zhonghua Zhong Liu Za Zhi. 25:376–379. 2003.(In Chinese). PubMed/NCBI
14	Lee JL, Park SI, Kim SB, Jung HY, Lee GH, Kim JH, Song HY, Cho KJ, Kim WK, Lee JS, et al: A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol. 15:947–954. 2004. View Article : Google Scholar : PubMed/NCBI
15	Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, Ackland S, Gotley DC, Joseph D, Millar J, et al Trans-Tasman Radiation Oncology Group, ; Australasian Gastro-Intestinal Trials Group, : Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: A randomised controlled phase III trial. Lancet Oncol. 6:659–668. 2005. View Article : Google Scholar : PubMed/NCBI
16	Natsugoe S, Okumura H, Matsumoto M, Uchikado Y, Setoyama T, Yokomakura N, Ishigami S, Owaki T and Aikou T: Randomized controlled study on preoperative chemoradiotherapy followed by surgery versus surgery alone for esophageal squamous cell cancer in a single institution. Dis Esophagus. 19:468–472. 2006. View Article : Google Scholar : PubMed/NCBI
17	Cao XF, He XT, Ji L, Xiao J and Lv J: Effects of neoadjuvant radiochemotherapy on pathological staging and prognosis for locally advanced esophageal squamous cell carcinoma. Dis Esophagus. 22:477–481. 2009. View Article : Google Scholar : PubMed/NCBI
18	Jin MG, Jiang SC and Chen ZW: Clinical trial of preoperative concurrent chemoradiation followed by surgery versus surgery alone for advanced esophageal carcinoma. China J Cancer Prev Treat. 15:1815–1817. 2008.
19	Peng L, Xie TP, Han YT, et al: Randomized controlled study on preoperative concurrent chemoradiotherapy versus surgery alone for esophageal squamous cell carcinoma. Tumor Chin. 28:620–622. 2008.
20	Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, Kiel K, Willett C, Sugarbaker D and Mayer R: Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol. 26:1086–1092. 2008. View Article : Google Scholar : PubMed/NCBI
21	Lv J, Cao XF, Zhu B, Ji L, Tao L and Wang DD: Long-term efficacy of perioperative chemoradiotherapy on esophageal squamous cell carcinoma. World J Gastroenterol. 16:1649–1654. 2010. View Article : Google Scholar : PubMed/NCBI
22	Jin FL, Zu-Liang HU and Hai-Feng MA: Treatment effect of neoadjuvant chemoradiotherapy followed by surgery versus surgery alone in local advanced esophageal carcinoma. Shiyong Zhongliu Zazhi. 26:523–526. 2011.
23	Yang H, Jh FU, Liu MZ, et al: A multi-centered randomized controlled study of neo-adjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of esophagus: an interim analysis). Natl Med J Chin (Chin). 92:1028–1032. 2006.(In Chinese).
24	Bass GA, Furlong H, O'Sullivan KE, Hennessy TP and Walsh TN: Chemoradiotherapy, with adjuvant surgery for local control, confers a durable survival advantage in adenocarcinoma and squamous cell carcinoma of the oesophagus. Eur J Cancer. 50:1065–1075. 2014. View Article : Google Scholar : PubMed/NCBI
25	Mariette C, Dahan L, Mornex F, Maillard E, Thomas PA, Meunier B, Boige V, Pezet D, Robb WB, Le Brun-Ly V, et al: Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: Final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 32:2416–2422. 2014. View Article : Google Scholar : PubMed/NCBI
26	Shapiro J, van Lanschot JJB, Hulshof MCCM, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, van Laarhoven HWM, Nieuwenhuijzen GAP, Hospers GAP, Bonenkamp JJ, et al CROSS study group, : Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): Long-term results of a randomised controlled trial. Lancet Oncol. 16:1090–1098. 2015. View Article : Google Scholar : PubMed/NCBI
27	van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, et al CROSS Group, : Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 366:2074–2084. 2012. View Article : Google Scholar : PubMed/NCBI
28	Law S, Kwong DL, Wong KH, Kwok KF and Wong J: The effects of neoadjuvant chemoradiation on pTNM staging and its prognostic significance in esophageal cancer. J Gastrointest Surg. 10:1301–1311. 2006. View Article : Google Scholar : PubMed/NCBI
29	Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A and Gebski V; Australasian Gastro-Intestinal Trials Group, : Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: An updated meta-analysis. Lancet Oncol. 12:681–692. 2011. View Article : Google Scholar : PubMed/NCBI
30	Gluud LL and Krag A: Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults. Cochrane Database Syst Rev. 8:CD0045442012.
31	Huang TC, Hsu CH, Lin CC and Tu YK: Systematic review and network meta-analysis: Neoadjuvant chemoradiotherapy for locoregional esophageal cancer. Jpn J Clin Oncol. 45:1023–1028. 2015. View Article : Google Scholar : PubMed/NCBI
32	Wijnhoven BP, van Lanschot JJ, Tilanus HW, Steyerberg EW and van der Gaast A: Neoadjuvant chemoradiotherapy for esophageal cancer: A review of meta-analyses. World J Surg. 33:2606–2614. 2009. View Article : Google Scholar : PubMed/NCBI
33	Baum ML, Anish DS, Chalmers TC, Sacks HS, Smith H Jr and Fagerstrom RM: A survey of clinical trials of antibiotic prophylaxis in colon surgery: Evidence against further use of no-treatment controls. N Engl J Med. 305:795–799. 1981. View Article : Google Scholar : PubMed/NCBI
34	Lau J, Antman EM, Jimenez-Silva J, Kupelnick B, Mosteller F and Chalmers TC: Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med. 327:248–254. 1992. View Article : Google Scholar : PubMed/NCBI
35	Jin HL, Zhu H, Ling TS, Zhang HJ and Shi RH: Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: A meta-analysis. World J Gastroenterol. 15:5983–5991. 2009. View Article : Google Scholar : PubMed/NCBI
36	Liu SL, Yang H, Zhang P, Zhang L, Zhao L, Luo LL, Fu JH, Liu MZ and Xi M: Neoadjuvant chemoradiotherapy with cisplatin plus vinorelbine versus cisplatin plus fluorouracil for esophageal squamous cell carcinoma: A matched case-control study. Radiother Oncol. 116:262–268. 2015. View Article : Google Scholar : PubMed/NCBI
37	Wolf M, Zehentmayr F, Niyazi M, Ganswindt U, Haimerl W, Schmidt M, Hölzel D and Belka C: Long-term outcome of mitomycin C- and 5-FU-based primary radiochemotherapy for esophageal cancer. Strahlenther Onkol. 186:374–381. 2010. View Article : Google Scholar : PubMed/NCBI