Role of Adjuvant Therapy in Esophageal Cancer Patients After Neoadjuvant Therapy and Esophagectomy

医学 新辅助治疗 辅助治疗 食管切除术 食管癌 内科学 佐剂 癌症 肿瘤科 乳腺癌
作者
Yung Lee,Yasith Samarasinghe,Michael H. Lee,Luxmy Thiru,Yaron Shargall,Christian Finley,Waël C. Hanna,Oren Levine,Rosalyn A. Juergens,John Agzarian
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
卷期号:275 (1): 91-98 被引量:29
标识
DOI:10.1097/sla.0000000000005227
摘要

Objective: The aim of this study was to analyze esophageal cancer patients who previously underwent neoadjuvant therapy followed by a curative resection to determine whether additional adjuvant therapy is associated with improved survival outcomes. Summary Background Data: Neoadjuvant therapy followed by surgery is the standard of care for locally advanced esophageal cancer, whereas adjuvant therapy is typically employed for patients with residual disease. However, the role of adjuvant therapy after a curative resection is still uncertain. Methods: MEDLINE, EMBASE, and CENTRAL databases were searched for studies comparing patients with esophageal cancer who underwent neoadjuvant therapy and curative resection with and without adjuvant therapy. Primary outcome was overall survival (OS), and random effects meta-analysis was conducted where appropriate. Grading of recommendations, assessment, development, and evaluation was used to assess the certainty of evidence. Results: Ten studies involving 6462 patients were included. When compared to patients who received neoadjuvant therapy and esophagectomy alone, adjuvant therapy groups experienced a significant decrease in mortality by 48% at 1 year (Risk Ratio (RR) 0.52, 95% confidence interval [CI] 0.41–0.65, P < 0.001, moderate certainty ). This reduction in mortality was carried through to 5-year follow-up (RR 0.91, 95% CI 0.86–0.96, P < 0.001, moderate certainty ). The difference between the adjuvant therapy and the control group was uncertain regarding the secondary outcomes. Conclusion: Adjuvant therapy after neoadjuvant treatment and esophagectomy with negative resection margins provide an improved OS at 1 and 5 years with moderate to high certainty of evidence, but the benefit for disease-free survival and locoregional/distal recurrence remain uncertain due to limited reporting of these outcomes.
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