Skip to main content
SpringerLink
Log in

Meta-Analysis for the Therapeutic Effect of Neoadjuvant Therapy in Resectable Esophageal Cancer

  • Original Article
  • Published:
Pathology & Oncology Research

Abstract

We aimed to review the therapeutic effects of neoadjuvant chemoradiotherapy (NCRT), chemotherapy (NCT), and radiotherapy (NRT) on patients with resectable Esophageal cancer (EsC) by comparison with surgery alone (SA). PubMed, EMBASE and Cochrane were searched for eligible studies published up to March 2015. Cochrane reviews were used for quality assessment. Eight primary outcomes were analyzed. Risk ratios (RRs)/ hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were calculated using the random- or fixed- effects model. Heterogeneity was assessed using the Chi-square-based Q statistic and the I 2test. Publication bias was examined by the Begg’s funnel plot. Totally 24 articles including 4718 EsC cases were eligible for this meta-analysis. The quality of the literatures was relatively high. Significant difference was found in five-year survival rate (RR = 1.45, 95% CI: 1.17–1.79, P < 0.01) between patients treated with NCT and SA, while the eight enrolled primary outcomes were all statistically different between NCRT and SA, and significant difference was identified in three-year survival between NCRT and NCT (RR = 1.35, 95% CI: 1.14–1.60, P < 0.01). No obvious publication bias was observed. NCRT and NCT provide an obvious benefit for EsC treatment over SA, and NCRT possesses a clear advantage compared with NCT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Pennathur A, Gibson MK, Jobe BA, Luketich JD (2013) Oesophageal carcinoma. Lancet 381:400–412

    Article  PubMed  Google Scholar 

  2. Vallbohmer D, Brabender J, Grimminger P, Schroder W, Holscher AH (2011) Predicting response to neoadjuvant therapy in esophageal cancer. Expert Rev Anticancer Ther 11:1449–1455

    Article  PubMed  Google Scholar 

  3. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249

    Article  PubMed  Google Scholar 

  4. Shahbaz Sarwar CM, Luketich JD, Landreneau RJ, Abbas G (2010) Esophageal cancer: an update. Int J Surg 8:417–422

    Article  CAS  PubMed  Google Scholar 

  5. Krasna MJ (2010) Multimodality therapy for esophageal cancer. Oncology (Williston Park) 24:1134–1138

    Google Scholar 

  6. D'journo XB, Thomas PA (2014) Current management of esophageal cancer. J Thorac Dis 6(Suppl 2):S253–S264

    PubMed  PubMed Central  Google Scholar 

  7. Baba Y, Watanabe M, Yoshida N, Baba H (2014) Neoadjuvant treatment for esophageal squamous cell carcinoma. World J Gastrointest Oncol 6:121–128

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shah RD, Cassano AD, Neifeld JP (2014) Neoadjuvant therapy for esophageal cancer. World J Gastrointest Oncol 6:403–406

    PubMed  PubMed Central  Google Scholar 

  9. Pandey D, Pandey R, Garg PK (2015) Neoadjuvant therapy and lymphadenectomy in esophageal cancer: both are essential to maximize survival benefit. Ann Surg. doi:10.1097/SLA.0000000000001160

  10. Berry MF (2014) Esophageal cancer: staging system and guidelines for staging and treatment. J Thorac Dis 6(Suppl 3):S289–S297

    PubMed  PubMed Central  Google Scholar 

  11. Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234

    Article  CAS  PubMed  Google Scholar 

  12. Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681–692

    Article  PubMed  Google Scholar 

  13. Higgins JP, Green S (2008) Cochrane handbook for systematic reviews of interventions, vol 5. Wiley Online Library, Chichester

    Book  Google Scholar 

  14. Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions, vol 5.1.0. Wiley Online Library, Chichester

    Google Scholar 

  15. Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE (2009) Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 27:5062–5067

    Article  PubMed  Google Scholar 

  16. Ancona E, Ruol A, Santi S et al (2001) Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma. Cancer 91:2165–2174

    Article  CAS  PubMed  Google Scholar 

  17. Boonstra JJ, Kok TC, Wijnhoven BP et al (2011) Chemotherapy followed by surgery versus surgery alone in patients with resectable oesophageal squamous cell carcinoma: long-term results of a randomized controlled trial. BMC Cancer 11:181

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bosset J-F, Gignoux M, Triboulet J-P et al (1997) Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337:161–167

    Article  CAS  PubMed  Google Scholar 

  19. Burmeister BH, Smithers BM, Gebski V et al (2005) Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol 6:659–668

    Article  PubMed  Google Scholar 

  20. Burmeister BH, Thomas JM, Burmeister EA et al (2011) Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial. Eur J Cancer 47:354–360

    Article  PubMed  Google Scholar 

  21. Cao XF, He XT, Ji L, Xiao J, Lv J (2009) Effects of neoadjuvant radiochemotherapy on pathological staging and prognosis for locally advanced esophageal squamous cell carcinoma. Dis Esophagus 22:477–481

    Article  PubMed  Google Scholar 

  22. Fujiwara Y, Yoshikawa R, Kamikonya N et al (2013) Neoadjuvant chemoradiotherapy followed by esophagectomy vs. surgery alone in the treatment of resectable esophageal squamous cell carcinoma. Mol Clin Oncol 1:773–779

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Kelsen DP, Ginsberg R, Pajak TF et al (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339:1979–1984

    Article  CAS  PubMed  Google Scholar 

  24. Law S, Fok M, Chow S, Chu K-M, Wong J (1997) Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 114:210–217

    Article  CAS  PubMed  Google Scholar 

  25. Lee J-L, Park S, Kim S-B et al (2004) A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol 15:947–954

    Article  CAS  PubMed  Google Scholar 

  26. Lv J, Cao X-F, Zhu B, Ji L, Tao L, Wang D-D (2010) Long-term efficacy of perioperative chemoradiotherapy on esophageal squamous cell carcinoma. World J Gastroenterol 16:1649

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Maipang T, Vasinanukorn P, Petpichetchian C et al (1994) Induction chemotherapy in the treatment of patients with carcinoma of the esophagus. J Surg Oncol 56:191–197

    Article  CAS  PubMed  Google Scholar 

  28. Mariette C, Dahan L, Mornex F et al (2014) Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol 32:2416–2422

    Article  CAS  PubMed  Google Scholar 

  29. Natsugoe S, Okumura H, Matsumoto M et al (2006) Randomized controlled study on preoperative chemoradiotherapy followed by surgery versus surgery alone for esophageal squamous cell cancer in a single institution. Dis Esophagus 19:468–472

    Article  CAS  PubMed  Google Scholar 

  30. Nygaard K, Hagen S, Hansen HS et al (1992) Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg 16:1104–1109

    Article  CAS  PubMed  Google Scholar 

  31. Prise EL, Etienne PL, Meunier B et al (1994) A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 73:1779–1784

    Article  PubMed  Google Scholar 

  32. Schlag PM (1992) Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus. Arch Surg 127:1446–1450

    Article  CAS  PubMed  Google Scholar 

  33. Stahl M, Walz MK, Stuschke M et al (2009) Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 27:851–856

    Article  CAS  PubMed  Google Scholar 

  34. Tepper J, Krasna MJ, Niedzwiecki D et al (2008) Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26:1086–1092

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M (2001) Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19:305–313

    Article  CAS  PubMed  Google Scholar 

  36. Van Hagen P, Hulshof M, Van Lanschot J et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074–2084

    Article  CAS  PubMed  Google Scholar 

  37. Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP (1996) A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335:462–467

    Article  CAS  PubMed  Google Scholar 

  38. Ychou M, Boige V, Pignon J-P et al (2011) Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29:1715–1721

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, The Second People’s Hospital of Liaocheng, Linqing, Shandong, 252600, China

    Yusen Zhu, Xiaojing Yun, Dongmei Wang, Yuhuan Bai, Guizhi Zhang, Bei Ji & Changchun Jing

  2. Department of Emergency, The Second People’s Hospital of Liaocheng, Linqing, Shandong, 252600, China

    Min Liu

Authors
  1. Yusen Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaojing Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dongmei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuhuan Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guizhi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bei Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Changchun Jing
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Min Liu.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhu, Y., Liu, M., Yun, X. et al. Meta-Analysis for the Therapeutic Effect of Neoadjuvant Therapy in Resectable Esophageal Cancer. Pathol. Oncol. Res. 23, 657–663 (2017). https://doi.org/10.1007/s12253-016-0164-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12253-016-0164-4

Keywords

Search

Navigation