Meta-analysis For The Therapeutic Effect And Safety Of Neoadjuvant Chemoradiotherapy In Resectable Esophageal Cancer

Purpose: To evaluate the efficacy and safety of neoadjuvant chemoradiotherapy(a CRTS group)plus surgery versus surgery alone(a SA group)in the treatment of resectable esophageal neoplasms.Methods: A comprehensive electronic literature search was performed via the MEDLINE(Pub Med),Cochrane Library,and Embase,Web of Science databases through November 2018 for the inclusion of randomized controlled trials(RCTs)that evaluated therapeutic effect and safety of patients administered NCRTS compared with surgery alone for resectable esophageal cancer.The main outcome measures were postoperative mortality and morbidity.Meta-analysis was conducted by using Revman5.3 software.Results: Fifteen RCTs included 2 623 patients(1 320 in the NCRTS group,1 303 in the SA group)were selected.There was a significantdifference between the CRTS group and the SA group in 3-year survival rate,5-year survival rate,R0 resection rate,localrecurrence rate,recurrence and metastasis rate with relative risk(RR)value and95%CI at 1.28(1.17–1.40,P<0.00001),1.32(1.15–1.50,P < 0.0001),1.19(1.07–1.31,P=0.0009),0.56(0.45–0.69,P < 0.00001),0.84(0.74–0.95,P= P=0.006).And there was no significant difference between the CRTS group and the SA group in 1-year survival rate and distant metastasis with RR(95%CI)of 1.03(0.97–1.09,P=0.35)and 0.88(0.76–1.01,P=0.06).There was no significantdifference in postoperative complications,pulmonary complications,anastomotic leakage,cardiac complications between the two groups with RR(95%CI)at 1.37(0.88–2.13,P=0.17),0.88(0.76–1.02,P=0.10),1.11(0.84–1.46,P=0.46),and 1.09(0.88–2.13,P=0.17).Conclusions: NCRTS significantly benefits to survival rate,R0 rescetion rate,and local recurrence rate compared to SA.There is no increased postoperative complication for patients with resectable esophageal neoplasms.