术后辅助治疗对新辅助治疗联合手术切除食管鳞状细胞癌患者预后影响的系统评价与Meta分析  

Prognostic impact of adjuvant therapy on patients with esophageal squamous cell carcinoma receiving neoadjuvant therapy plus esophagectomy:A systematic review and meta-analysis

作　　者：胡子豪 宋佩东 陈东来 徐塑凯 谭黎杰 桑永华[1] 陈勇兵[1] HU Zihao;SONG Peidong;CHEN Donglai;XU Sukai;TAN Lijie;SANG Yonghua;CHEN Yongbing(Department of Thoracic Surgery,The Second Affiliated Hospital of Soochow University,Suzhou,215004,Jiangsu,P.R.China;Department of Thoracic Surgery,Zhongshan Hospital,Fudan University,Shanghai,200032,P.R.China)

机构地区：[1]苏州大学附属第二医院胸心外科,江苏苏州215004 [2]复旦大学附属中山医院胸外科,上海200032

出　　处：《中国胸心血管外科临床杂志》2024年第10期1505-1513,共9页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：苏州市科技计划项目(SKJY2021076);苏州大学省部共建放射医学与辐射防护国家重点实验室开放课题(GZK1202216)。

摘　　要：目的探讨辅助治疗能否给接受新辅助治疗联合食管癌根治术的食管鳞状细胞癌(鳞癌)患者带来生存获益。方法检索建库至2022年11月PubMed、EMbase、The Cochrane Library、Web of Science、中国知网数据库中的相关文献,筛选符合研究目的的研究,从中提取总生存期(overall survival,OS)、无复发生存期(recurrence-free survival,RFS)结局指标。通过RevMan 5.4与Stata 14.0软件进行Meta分析。结果最终纳入9项研究,共计1340例患者。与新辅助治疗联合手术治疗(NS)组相比,新辅助治疗联合手术+术后辅助治疗(NS+A)组在OS上无显著获益[HR=0.88,95%CI(0.75,1.02),P=0.09],而在RFS上有显著获益[HR=0.75,95%CI(0.58,0.97),P=0.03]。按术后淋巴结状态进行亚组分析表明,辅助治疗可延长淋巴结阳性患者的RFS。术后淋巴结包含阳性与阴性的患者有OS获益,而术后淋巴结阳性患者未见OS获益。针对辅助治疗用药方案的亚组分析中,三联用药的术后用药方案仅在延长RFS上具有优势,未能改善OS。而二联用药方案对患者生存无显著改善。对于术后辅助治疗方案的亚组分析显示,术后辅助放化疗与术后辅助化疗均未改善OS,仅术后辅助放化疗可延长RFS。结论术后辅助治疗对于新辅助治疗联合手术治疗后的食管鳞癌患者预后有所改善。Objective To investigate whether adjuvant therapy can bring survival benefits to patients with esophageal squamous cell carcinoma(ESCC)who have received neoadjuvant therapy plus esophagectomy.Methods Studies were identified by searching databases including PubMed,EMbase,Web of Science,The Cochrane Library and CNKI from inception to November 2022 to collect studies which conformed to the objective of this study.Clinical outcomes including overall survival(OS)and recurrence-free survival(RFS)were extracted from eligible studies after screening.RevMan 5.4 and Stata 14.0 were used to perform the meta-analysis.Results A total of 9 studies were selected including 1340 patients.Compared with the neoadjuvant therapy plus surgery(NS)group,the neoadjuvant therapy plus surgery+adjuvant therapy(NS+A)group had no significant benefit in the OS[HR=0.88,95%CI(0.75,1.02),P=0.09],but had remarkable benefit in the RFS[HR=0.75,95%CI(0.58,0.97),P=0.03].Subgroup analysis by nodal status showed that adjuvant therapy could improve the RFS of patients with node-positive disease.Prolonged OS was observed in the patients with both positive and negative nodes but not in the patients with only positive nodes.In terms of the subgroup analysis by prescription,it revealed that triple agents exhibited advantages in improving RFS but not OS.However,dual agents did not bring additional survival benefits to the NS+A group compared with the NS group.Subgroup analysis by adjuvant therapy indicated that neither postoperative chemoradiotherapy nor chemotherapy improved OS,whereas postoperative chemoradiation elongated RFS.Conclusion Adjuvant therapy can improve the prognosis of patients with ESCC after neoadjuvant therapy followed by esophagectomy.

关 键 词：食管鳞癌 新辅助治疗 辅助治疗 系统评价/META分析 

分 类 号：R735.1[医药卫生—肿瘤]