title: Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: a meta-analysis.
abstract: OBJECTIVE
  To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma.
  
  
  METHODS
  We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed. Trial validity assessment was performed and a trial quality score was assigned.
  
  
  RESULTS
  Eleven randomized controlled trials (RCTs) including 1308 patients were selected. Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone. Odds ratio (OR) [95% confidence interval (CI), P value], expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone, was 1.28 (1.01-1.64, P = 0.05) for 1-year survival, 1.78 (1.20-2.66, P = 0.004) for 3-year survival, and 1.46 (1.07-1.99, P = 0.02) for 5-year survival. Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy (OR: 1.68, 95% CI: 1.03-2.73, P = 0.04), but incidence of postoperative complications was similar in two groups (OR: 1.14, 95% CI: 0.88-1.49, P = 0.32). Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence (OR: 0.64, 95% CI: 0.41-0.99, P = 0.04), but incidence of distant cancer recurrence was similar (OR: 0.94, 95% CI: 0.68-1.31, P = 0.73). Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvant chemoradiotherapy, OR (95% CI, P value) was 1.16 (0.85-1.57, P = 0.34) for 1-year survival, 1.34 (0.98-1.82, P = 0.07) for 3-year survival and 1.41 (0.98-2.02, P = 0.06) for 5-year survival.
  
  
  CONCLUSIONS
  Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.
authors.affiliation: Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Hai-Lin
authors.initials: HL
authors.lastname: Jin
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.forename: Ting-Sheng
authors.initials: TS
authors.lastname: Ling
authors.forename: Hong-Jie
authors.initials: HJ
authors.lastname: Zhang
authors.forename: Rui-Hua
authors.initials: RH
authors.lastname: Shi
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D020360:Neoadjuvant Therapy; D016017:Odds Ratio; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015996:Survival Rate