Survival after neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: A meta‐analysis

Background The efficacy of surgery alone for patients with locally advanced esophageal cancer ( EC ) is still unsatisfactory. Presently, induction therapy followed by surgery is the standard treatment. Preoperative chemotherapy ( CT ) and chemoradiation ( CRT ) are proven effective induction therapies; however, few sample studies have addressed these treatments, thus, their superiority remains uncertain. We performed a systemic review and meta analysis to test the hypothesis that induction CRT prior to surgery could improve survival compared with induction CT alone. Methods A comprehensive search of PubMed and the Ovid database for relevant studies comparing EC patients undergoing resection after treatment with induction CT alone or induction CRT was conducted. Hazard ratios ( HR ) and 95% confidence intervals (95% CI ) were extracted from these studies to provide pooled estimates of the effect of induction therapy on overall survival. Results Five studies met the criteria for analysis. Statistical analysis demonstrated a survival benefit of induction CRT compared with induction CT alone ( HR 0.73, 95% CI 0.61–0.89; P = 0.002). Further analysis showed that induction CRT perioperative mortality and complication rates were higher than for induction CT alone ( HR 2.96, 95% CI 1.38–6.37; HR 1.6, 95% CI 1.30–1.98; P = 0.01, respectively). Conclusions Published evidence comparing the different efficacies of induction CT and induction CRT is sparse, with few samples of adenocarcinoma. This analysis supports the view that, compared with induction CT , induction CRT could achieve a long‐term survival benefit in EC patients.