Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer: A meta-analysis

ARTICLE HIGHLIGHTS

Research background

Esophageal cancer (EC) treatment using neoadjuvant therapy has shown potential advantages in controlling micrometastasis and improving surgical outcomes. However, the optimal choice between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) remains debated.

Research motivation

The study aimed to compare the efficacy and reliability of nCRT and nCT in the prevention and treatment of EC, addressing the lack of consensus in the literature and providing guidance for future research in this field.

Research objectives

The study aimed to analyze various outcomes such as overall survival rates (OSR), pathological complete response rates, R0 clearance rates (CR), and the incidence of complications to determine the advantages and disadvantages of nCRT and nCT in EC treatment.

Research methods

A comprehensive meta-analysis was conducted, incorporating three randomized controlled trials and 17 case-control and cohort studies. The analysis involved statistical calculations, including odds ratios, confidence intervals, P values, and I2 statistics, to assess the differences and heterogeneity among the studies.

Research results

The study found that nCRT outperformed nCT in terms of the 3-year OSR, pathological complete response rate, and R0 CR. However, nCT showed a lower incidence of postoperative cardiopulmonary complications and perioperative mortality. Other outcomes did not show statistically significant differences.

Research conclusions

The study concludes that nCRT is more effective in terms of 3-year survival outcomes and tumor response, particularly in esophageal squamous cell carcinoma cases. On the other hand, nCT is associated with lower postoperative complications and mortality rates. The choice of neoadjuvant therapy should consider the patient's specific conditions and treatment sensitivities.

Research perspectives

Future research should focus on comparing specific subgroups, such as esophageal squamous cell carcinoma, and explore tailored approaches to neoadjuvant therapy to optimize survival outcomes while minimizing complications. Additionally, further investigation is needed to address the limitations of the included studies, such as observational designs and potential variations in surgical selection and dosing.