Comparison Of The Effect Of Postoperative Radiotherapy With Surgery Alone For ESCC Patients: A Meta-analysis

Objective:This dissertation was conducted to evaluate the effect of postoperative radiotherapy?PRT?for esophagus squamous cell carcinoma?ESCC?after radical surgery alone?SA?.Methods:A comprehensive research was performed in Pubmed,Embase and Cochrane Library electronic databases.Full articles that compared PRT with SA in esophageal esophagus cell carcinoma patients were collected published.Results:Four randomized-controlled trials?RCTs?with 1050 participants and 8 non-randomized-controlled trials?NRCTs?with 3248 participants were included and evaluated separately.The risk ratio?RR?rate and its 95%confidential interval?95%CI?were calculated.Both RCTs and NRCTs groups showed that PRT increased 3-year overall survival?OS?rate(RR_RCT=0.89,95%CI:0.80-0.99;RR_NRCT=0.82,95%CI:0.76-0.88)and reduced locoregional recurrence(RR_RCT=0.53,95%CI:0.43-0.66;RR_NRCT=0.47,95%CI:0.32-0.69)as compared with SA.Subgroup analysis according to pathological lymph node status revealed that PRT was likely to improve OS regardless of pathological lymph node status(Pathological lymph node positive patients:RR_{5-year os-RCT}=0.81,95%CI:0.70-0.93;RR_{5-year os-NRCT}=0.87,95%CI:0.80-0.94;Pathological lymph node negative patients:RR_{3-year os-RCT}=0.76,95%CI:0.59-0.96;RR_{3-year os-NRCT}=0.52,95%CI:0.30-0.89).No effect on distant recurrence rate was detected.Adverse effects were comparatively modest and tolerable.Conclusion:PRT was promising in improving OS and reducing the LR rate.More large-scale up-to-date RCTs are needed to further validate the use of PRT in modern practice.