Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2024; 16(1): 214-233
Published online Jan 15, 2024. doi: 10.4251/wjgo.v16.i1.214
Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer: A meta-analysis
Mao-Xiu Yuan, Qi-Gui Cai, Zhen-Yang Zhang, Jian-Zhong Zhou, Cai-Yun Lan, Jiang-Bo Lin
Mao-Xiu Yuan, The Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, China
Mao-Xiu Yuan, Qi-Gui Cai, Jian-Zhong Zhou, Cai-Yun Lan, Department of Thoracic Surgery, Affiliated Hospital of Jinggangshan University, Ji’an 343000, Jiangxi Province, China
Zhen-Yang Zhang, Jiang-Bo Lin, Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, Fujian Province, China
Author contributions: Lin JB, Cai QG and Zhang ZY were responsible for research design; Zhou JZ, and Lan CY were responsible for conducting the experiments; Yuan MX, Cai QG, Zhang ZY and Lan CY were responsible for data acquisition; Yuan MX and Lin JB were responsible for data analysis; Yuan MX were responsible for writing the manuscript; All the authors have contributed to the completion of this paper.
Conflict-of-interest statement: No conflicts of interest exits in the submission of this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jiang-Bo Lin, MD, Chief Physician, Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350000, Fujian Province, China.
Received: September 19, 2023
Peer-review started: September 19, 2023
First decision: October 9, 2023
Revised: October 20, 2023
Accepted: December 4, 2023
Article in press: December 4, 2023
Published online: January 15, 2024
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.