Abstract：
The best pattern of neoadjuvant therapy for resectable locoregional esophageal cancer has not been determined. Our study evaluated the efficacy and postoperative events of different treatments using the Bayesian network meta-analysis.
We systematically tracked randomized clinical trials from the Medline, EMBASE, and Cochrane Library databases. The following treatments were included: neoadjuvant chemoradiation followed by surgery (NCRT + S), neoadjuvant chemotherapy followed by surgery (NCT + S), neoadjuvant radiotherapy followed by surgery (NRT + S), and surgery alone (S). The Revised Cochrane risk-of-bias tools were used to assess the quality of included trials. Overall survival (OS) and progression-free survival or disease-free survival (PFS/DFS) were assessed through hazard ratios (HR). Locoregional recurrence, distant metastasis, postoperative mortality, and postoperative morbidity were assessed through odds ratios (OR). These outcomes were compared between different treatments through Bayesian network meta-analysis.
Twenty trials with 4384 patients were included. Compared with S, only NCRT + S could significantly improve OS for patients with esophageal cancer (HR = 0.78, 95% confidence interval [CI] 0.68-0.88). NCRT + S and NCT + S significantly improved PFS/DFS compared with S (NCRT + S vs. S, HR = 0.72, 95% CI 0.63-0.81; NCT + S vs. S, HR = 0.81, 95% CI 0.69-0.97). NCRT + S significantly reduced both locoregional recurrence (OR = 0.67, 95% CI 0.51-0.88) and distant metastasis (OR = 0.63, 95% CI 0.45-0.90) compared with S. There were no differences in postoperative morbidity between the four treatments. However, NCRT + S also increased postoperative mortality compared with S (OR = 1.77, 95% CI 1.09-2.82) and NCT + S (OR = 1.96, 95% CI 1.11-3.51).
NCRT + S is the most efficient neoadjuvant treatment for resectable locoregional esophageal cancer. However, NCRT + S increases the risk of postoperative mortality but not morbidity.
We systematically tracked randomized clinical trials from the Medline, EMBASE, and Cochrane Library databases. The following treatments were included: neoadjuvant chemoradiation followed by surgery (NCRT + S), neoadjuvant chemotherapy followed by surgery (NCT + S), neoadjuvant radiotherapy followed by surgery (NRT + S), and surgery alone (S). The Revised Cochrane risk-of-bias tools were used to assess the quality of included trials. Overall survival (OS) and progression-free survival or disease-free survival (PFS/DFS) were assessed through hazard ratios (HR). Locoregional recurrence, distant metastasis, postoperative mortality, and postoperative morbidity were assessed through odds ratios (OR). These outcomes were compared between different treatments through Bayesian network meta-analysis.
Twenty trials with 4384 patients were included. Compared with S, only NCRT + S could significantly improve OS for patients with esophageal cancer (HR = 0.78, 95% confidence interval [CI] 0.68-0.88). NCRT + S and NCT + S significantly improved PFS/DFS compared with S (NCRT + S vs. S, HR = 0.72, 95% CI 0.63-0.81; NCT + S vs. S, HR = 0.81, 95% CI 0.69-0.97). NCRT + S significantly reduced both locoregional recurrence (OR = 0.67, 95% CI 0.51-0.88) and distant metastasis (OR = 0.63, 95% CI 0.45-0.90) compared with S. There were no differences in postoperative morbidity between the four treatments. However, NCRT + S also increased postoperative mortality compared with S (OR = 1.77, 95% CI 1.09-2.82) and NCT + S (OR = 1.96, 95% CI 1.11-3.51).
NCRT + S is the most efficient neoadjuvant treatment for resectable locoregional esophageal cancer. However, NCRT + S increases the risk of postoperative mortality but not morbidity.
摘要：
新辅助治疗可切除局部食管癌的最佳模式尚未确定。我们的研究使用贝叶斯网络荟萃分析评估了不同治疗方法的疗效和术后事件。
我们系统地跟踪了Medline的随机临床试验，EMBASE,和Cochrane图书馆数据库。包括以下治疗：新辅助放化疗，然后手术（NCRT+S），新辅助化疗后手术（NCT+S），新辅助放疗后手术（NRT+S），和单独手术（S）。使用修订的Cochrane偏倚风险工具评估纳入试验的质量。通过风险比（HR）评估总生存期（OS）和无进展生存期或无疾病生存期（PFS/DFS）。局部复发，远处转移,术后死亡率,术后发病率通过比值比(OR)进行评估.通过贝叶斯网络荟萃分析比较不同治疗方法之间的这些结果。
20项试验纳入4384例患者。与S相比,只有NCRT+S能显著改善食管癌患者的OS(HR=0.78,95%置信区间[CI]0.68~0.88)。与S相比，NCRT+S和NCT+S显著改善了PFS/DFS（NCRT+S与S,HR=0.72，95%CI0.63-0.81；NCT+Svs.S,HR=0.81，95%CI0.69-0.97）。与S相比，NCRTS显着降低了局部复发（OR=0.67，95％CI0.51-0.88）和远处转移（OR=0.63，95％CI0.45-0.90）。四种治疗方法之间的术后发病率没有差异。然而,与S（OR=1.77，95％CI1.09-2.82）和NCTS（OR=1.96，95％CI1.11-3.51）相比，NCRTS也增加了术后死亡率。
NCRT+S是可切除局部食管癌最有效的新辅助治疗方法。然而,NCRT+S会增加术后死亡率的风险，但不会增加发病率。
我们系统地跟踪了Medline的随机临床试验，EMBASE,和Cochrane图书馆数据库。包括以下治疗：新辅助放化疗，然后手术（NCRT+S），新辅助化疗后手术（NCT+S），新辅助放疗后手术（NRT+S），和单独手术（S）。使用修订的Cochrane偏倚风险工具评估纳入试验的质量。通过风险比（HR）评估总生存期（OS）和无进展生存期或无疾病生存期（PFS/DFS）。局部复发，远处转移,术后死亡率,术后发病率通过比值比(OR)进行评估.通过贝叶斯网络荟萃分析比较不同治疗方法之间的这些结果。
20项试验纳入4384例患者。与S相比,只有NCRT+S能显著改善食管癌患者的OS(HR=0.78,95%置信区间[CI]0.68~0.88)。与S相比，NCRT+S和NCT+S显著改善了PFS/DFS（NCRT+S与S,HR=0.72，95%CI0.63-0.81；NCT+Svs.S,HR=0.81，95%CI0.69-0.97）。与S相比，NCRTS显着降低了局部复发（OR=0.67，95％CI0.51-0.88）和远处转移（OR=0.63，95％CI0.45-0.90）。四种治疗方法之间的术后发病率没有差异。然而,与S（OR=1.77，95％CI1.09-2.82）和NCTS（OR=1.96，95％CI1.11-3.51）相比，NCRTS也增加了术后死亡率。
NCRT+S是可切除局部食管癌最有效的新辅助治疗方法。然而,NCRT+S会增加术后死亡率的风险，但不会增加发病率。
