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Meta-analysis of postoperative efficacy in patients receiving chemoradiotherapy followed by surgery for resectable esophageal carcinoma

Jiaying Deng1, Chunyu Wang1, Mingqiong Xiang2, Fatao Liu3, Yun Liu4* and Kuaile Zhao1*

Author Affiliations

1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China

2 Shanghai Entry-Exit Inspection and Quarantine Bureau, 1208 Minsheng Road, Shanghai 200120, China

3 Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Graduate School of the Chinese Academy of Sciences, Shanghai 200031, P. R. China

4 Institutes of Biomedical Sciences, Fudan University, Ming Dao Building, 138 Yi Xue Yuan Road, Shanghai 200032, China

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Diagnostic Pathology 2014, 9:151  doi:10.1186/1746-1596-9-151

Published: 16 July 2014

Abstract

Background

Many studies have demonstrated that chemoradiotherapy followed by surgery (CRTS) prolongs the 5-year survival rate of resectable esophageal carcinoma patients. However, the effect of CRTS on postoperative complications, local recurrence and distant metastasis remains controversial. We performed a systematic review of the literature and conducted a meta-analysis to assess the postoperative efficacy of CRTS compared with surgery alone (SA).

Methods

Pubmed, Web of Science and the Cochrane library Databases were used to identify published studies between 2000 and 2013 that directly compared CRTS with SA. The pooled relative risk (RR) and its corresponding 95% confidence interval (95% CI) constituted the principal measure of treatment effects. Heterogeneity was assessed by the χ2 and I2 statistic.

Results

The final analysis included 1930 resectable esophageal carcinoma cases from 13 randomized controlled trials (RCTs). Compared with SA, CRTS was associated with significantly decreased postoperative mortality, local recurrence and distant metastasis rates, with RR (95% CI) = 0.64 (0.49–0.84), 0.53 (0.39–0.73), 0.82 (0.68–0.98); p = 0.001, <0.00001, =0.03, respectively. However, there was no significant difference in postoperative complication incidence between the two groups (RR, 1.09; 95% CI, 0.96–1.24; p = 0.18).

Conclusions

CRTS significantly decreased postoperative mortality, local recurrence and distant metastasis rates compared to SA. Additionally, there were no increased postoperative complications for patients with resectable esophageal carcinoma.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1531519216130950 webcite

Keywords:
Esophageal carcinoma; Chemoradiotherapy followed by surgery; Surgery alone; Randomized controlled trial; Meta-analysis