可切除食管鳞癌新辅助同步放化疗加手术对比单纯手术的疗效及安全性Meta分析

目的 系统评价可切除食管鳞癌新辅助同步放化疗+手术与单纯手术模式的有效性及安全性差异。方法 计算机检索Embase、Pubmed、Web of Science、Cochrane library、万方、中国知网、中国生物医学文献数据库等,查找辅助同步放化疗联合手术对比单纯手术治疗可切除食管鳞癌的临床随机对照研究文献。使用Revman 5.3统计软件对生存资料、R0切除率、术后并发症发生率及治疗期间死亡率进行Meta分析。结果 最终纳入11个临床随机对照研究文献,共计1450例患者。结果显示新辅助同步放化疗+手术组有更高的2、5年总生存率(RR=1.14,95%CI为1.05~1.23,P=0.00)和2、5年无进展生存率(RR=1.56,95%CI为1.05~2.32,P=0.03);提高了R0切除率(RR=1.10,95%CI为1.05~1.14,P=0.00),术后心律失常发生率也较高(RR=2.45,95%CI为1.37~4.38,P=0.00)。两组术后并发症总发生率和治疗期间死亡率均相近(RR=1.12,95%CI为0.79~1.59,P=0.51和RR=1.78,95%CI为0.90~3.52,P=0.10)。结论 可切除食管鳞癌新辅助同步放化疗+手术较单纯手术带来更多生存获益,并未明显增加不良反应发生率,是治疗可切除食管鳞癌的一种可选方案。

Efficacy and safety of neoadjuvant concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma:a Meta-analysis

Objective To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma. Methods Literature review was performed from Embase,PubMed,Web of Science,Cochrane Library,CBM,Wanfang Data,CNKI and Chongqing VIP. The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved. The meta-analysis of survival data,R0 resection rate,incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software. Results A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis. The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14,95%CI:1.05-1.23,P=0.00) and progression-free survival rate (RR=1.56,95%CI:1.05-2.32,P=0.03).R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10,95%CI:1.05-1.14,P=0.00). Compared with the surgery alone group,the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was significantly higher (RR=2.45,95%CI:1.37-4.38,P=0.00). However,there was no significant difference in the overall incidence of postoperative complications (RR=1.12,95%CI:0.79-1.59,P=0.51) and incidence of peritreatment mortality (RR=1.78, 95%CI:0.90-3.52,P=0.10) between two groups. Conclusion s Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma, whereas it does not increase the risk of postoperative complications. Consequently,neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma.