Comparison Of The Efficacy And Safety On Neoadjuvant Chemoradiotherapy And Neoadjuvant Chemotherapy In The Treatment Of Esophageal Cancer:A Meta-analysis

Background and & Object:Esophageal cancer is one of the most common malignant tumor,early esophageal standard treatment is surgical resection,but early esophageal cancer is mostly asymptomatic,most patients are already in the local advanced stage when diagnosed,and there is not great effective of surgery alone.According to the situation,the treatment of esophageal cancer has entered the era of multidisciplinary comprehensive treatment.The neoadjuvant therapy combined with surgical treatment has obvious effect.Common neoadjuvant therapy includes neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.At present,the best neoadjuvant therapy is controversial.This article compares the efficacy and safety of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in the treatment of esophageal cancer,with a view to providing relevant evidence for clinical decision-making.Methods:We systematically searched the literature on the efficacy and safety of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for esophageal cancer on pubmed,Embase,Cochrane,web of science databases,and took a meta analysis on extracted relevant data from the literatures by using RveMan 5.2 software.Results:A total of 5 randomized controlled studies and 12 retrospective studies were included.A total of 4167 patients with esophageal cancer were included,including1873 in the neoadjuvant chemotherapy group and 2294 in the neoadjuvant chemoradiotherapy group.The results of meta analysis showed that the 3-year overall survival(OR = 0.73,95% CI:0.61–0.87,P = 0.0006),pathological complete response rate(OR = 0.17,95% CI:0.13–0.22,P < 0.00001),R0 resection rate(OR = 0.38,95% CI:0.25–0.58,P < 0.0001)and the 3-year overall survival rate of squamous cell carcinoma subtypes(OR = 0.58,95% CI:0.39–0.86,P = 0.006)in the neoadjuvantchemotherapy group was lower than that of the neoadjuvant chemoradiotherapy group,and the difference was statistically significant;the 5-year overall survival rate(OR = 0.86,95% CI:0.71–1.03,P = 0.11),the 3-year overall survival rate of the adenocarcinoma subtype(OR = 0.83,95% CI : 0.66–1.04,P = 0.11),the local recurrence rate(OR = 1.18,95% CI:0.91–1.53,P = 0.21)and the distant metastasis rate(OR = 1.11,95% CI : 0.90–1.37,P = 0.34)showed the difference was no statistically significant.Security aspects: the incidence of postoperative cardiac complications(OR = 0.79,95%CI:0.62–0.99,P = 0.04),the incidence of pulmonary complications(OR = 0.69,95%CI : 0.50–0.95,P = 0.02)and the perioperative mortality(OR = 0.45,95%CI : 0.30–0.69,P = 0.0002)in the neoadjuvant chemotherapy group were lower than those in the neoadjuvant chemoradiotherapy group,with statistically significant differences;There was no statistical difference in the incidence of anastomotic leakage(OR = 0.91,95%CI:0.69–1.19,P = 0.49).Conclusion:Neoadjuvant chemoradiotherapy for esophageal cancer has higher 3-year overall survival rate,pathological complete response rate and R0 resection rate than neoadjuvant chemotherapy.The advantage of 3-year overall survival rate is more obvious in the type of esophageal squamous cell carcinoma.Neoadjuvant chemoradiotherapy has a higher incidence of postoperative cardiopulmonary complications and perioperative mortality than neoadjuvant chemotherapy.There was no statistical difference between the two neoadjuvant treatments for esophageal cancer in terms of 5-year overall survival rate,local recurrence rate,distant metastasis rate and incidence of anastomotic leakage.