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Meta-analysis of survival benefit with postoperative chemoradiotherapy in patients of lymph node positive esophageal carcinoma

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Abstract

Background

The effect of postoperative chemoradiotherapy (CRT) for esophageal carcinoma (EC) was investigated. Patients who can obtain benefit from this treatment modality have not yet been well identified.

Methods

We searched PubMed, Embase, Web of Science, and the Cochrane Library for studies published from January 1993 to July 2016. Research comparing surgery alone (SA) with postoperative CRT in patients with resectable EC was procured; collected articles were written in English.

Results

Nine studies comparing of postoperative CRT versus SA (n = 1650) in patients with resectable EC met the inclusion criteria. No survival benefit was achieved for postoperative CRT compared with SA. Subgroup analysis was conducted for patients under resection with positive lymph node carcinoma; there was a significant survival benefit at 1 year [risk ratio (RR) = 0.55 95% CI: 0.37–0.82; P = 0.003], 3 years (RR = 0.71 95% CI: 0.61–0.83; P<0.0001), as well as 5 years (RR = 0.86 95% CI: 0.78–0.94; P = 0.0007). Subgroup analysis by tumor histology of squamous cell carcinoma (SCC) was also performed, but there was no significant survival benefit when postoperative CRT was compared with SA. Fail models after surgery were performed; the RR for local control rate and distant metastasis rate were 0.64 (95% CI 0.49–0.85; P = 0.002) and 0.87 (95% CI 0.67–1.15; P = 0.34), which indicates lower local recurrence rates of post-CRT than that of SA.

Conclusion

This meta-analysis demonstrated a survival benefit of postoperative CRT over SA in resectable EC patients with positive lymph nodes. Improvements of local control rates with postoperative CRT were also detected.

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Acknowledgements

We appreciate Kyle Vaughn Laster (Hormel Cancer Institute, USA) for editing the language of the present manuscript.

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Authors and Affiliations

  1. Division of Graduate, The Second Clinical Medical School and the Second Affiliated Hospital of Zhengzhou University, Henan, China

    H. Luo

  2. Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450000, China

    H. Luo, Y. Y. Cui, Y. N. Sun, X. L. Zheng, C. L. Yang, K. Ye & H. Ge

  3. Division of Scientific Research and Education, The Affiliated Cancer Hospital of Zhengzhou University, Henan, China

    J. G. Zhang

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Correspondence to H. Ge.

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Funding

This work was supported by the National Natural Science Foundation of China [Grant no 81372436, 81773230], the Science and Technology Innovative Research Group of Zhengzhou city [Grant no 121PCXTD524], and the Joint Research Funds of Henan province and the Minister of Health of China [Grant no 201201009].

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Luo, H., Cui, Y.Y., Zhang, J.G. et al. Meta-analysis of survival benefit with postoperative chemoradiotherapy in patients of lymph node positive esophageal carcinoma. Clin Transl Oncol 20, 889–898 (2018). https://doi.org/10.1007/s12094-017-1803-2

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