Meta Analysis Of Prognostic Effects Of Two Neoadjuvant Treatment Models On Local Advanced Esophageal Carcinoma

Background and purpose:Esophageal cancer(EC)is a common malignant tumor in the world.The main treatment of esophageal cancer is surgical treatment,and preoperative neoadjuvant treatment can improve the survival rate of patients with locally advanced esophageal cancer.There are two kinds of neoadjuvant therapy: neoadjuvant chemoradiotherapy(n CRT)and neoadjuvant chemotherapy(n CT).Whether preoperative radiotherapy and chemotherapy or preoperative chemotherapy alone is still controversial for local advanced esophageal cancer.Relevant retrospective studies show that although the therapeutic effect of the two is better than that of simple surgical treatment,n CRT comparison n CT because of the increase of toxic side effects,can not improve survival and only improve local control.By meta analysis,the clinical efficacy and side effects of neoadjuvant chemoradiotherapy for esophageal cancer were compared,so as to provide a better theoretical basis for clinical treatment.Methods:Through retrieval database Pub Med、The Cochrane Library and Embase of 2010 to 2020 on esophageal cancer patients n CRT contrast n CT treatment related articles.The key words of the search mainly include the theme word "Esophageal Neoplasms" and its related entry terms," neoadjuvant chemoradiotherapy" 、 "neoadjuvant chemotherapy" and Screening articles by developing inclusion criteria and exclusion criteria,And the literature quality evaluation of the study.Finally,through revman5.3.3 analysis of the data extracted from the article,major study indicators included: R0 resection rate,pathologic complete response rate,postoperative 30-day mortality rate,overall survival rate of 3 and 5 years,and disease-free survival rate,cardiopulmonary complications,and survival comparison of pathological types.The effect size is reflected by OR、HR and 95% CI.Results:In this study,3 randomized controlled studies,19 case-control studies and 3cohort studies were included in 15275 esophageal cancer patients.The final data analysis showed that in the randomized controlled study,although there was no statistical difference in postoperative mortality after the two treatment models,There was no statistical difference between neoadjuvant chemoradiotherapy group 3 years OS and 5 years OS compared with neoadjuvant chemotherapy group.The same results were obtained for 3 years PFS and 5 years PFS.Compared with neoadjuvant chemotherapy group,neoadjuvant chemoradiotherapy group significantly increased the resection rate and pathologic complete response rate,and the difference was statistically significant.Since only one randomized controlled study included esophageal cancer patients with squamous cell carcinoma,the difference in therapeutic efficacy could not be compared according to the pathological classification differences between adenocarcinoma and squamous cell carcinoma.In case-control studies and cohort studies,induction radiotherapy and chemotherapy showed the same results compared with induction chemotherapy.Induced radiotherapy and chemotherapy had more advantages in local control of tumor,and could simultaneously improve the resection rate and pathologic complete response rate.There was a statistical difference between the two.Induced radiotherapy and chemotherapy did not increase postoperative mortality compared with chemotherapy,and no matter 3 years PFS、OS or 5 years PFS,the prognosis of induced chemoradiotherapy group was better than that of chemotherapy group.On side effects,n CRT increased cardiac side effects compared with n CT,but not pulmonary side effects.Inclusion:Compared with neoadjuvant chemotherapy,neoadjuvant chemoradiotherapy group had higher complete pathological remission rate and R0 resection rate in randomized controlled studies.However,the improvement of local control rate in neoadjuvant chemoradiotherapy group could not be transformed into overall survival rate and disease-free survival rate of esophageal cancer and gastroesophageal junction cancer.In case-control studies and cohort studies,we obtained different results.The neoadjuvant chemoradiotherapy group had a better prognosis than the neoadjuvant chemotherapy,and although there was no difference in postoperative mortality and lung complications,they increased heart complications compared to the neoadjuvant chemotherapy.Moreover,there is no difference in the prognosis of the two new adjuvant treatment modes for different pathological types.