title: A systematic review and network meta-analysis of neoadjuvant therapy combined with surgery for patients with resectable esophageal squamous cell carcinoma.
abstract: BACKGROUND
  The role of neoadjuvant therapy combined with surgery for treating esophageal squamous cell carcinoma (ESCC) remains controversial. We performed a network meta-analysis to synthesize direct and indirect evidence to identify the optimal therapeutic method for ESCC.
  
  
  METHODS
  We identified 15 randomized controlled trials that compared any of the following 4 therapeutic measures: surgery alone (S), preoperative chemotherapy followed by surgery (CTS), preoperative radiotherapy followed by surgery (RTS), and preoperative chemoradiotherapy followed by surgery (CRTS). The main outcomes were 5-year survival, rate of radical resection, operative mortality and postoperative complications.
  
  
  RESULTS
  Network meta-analysis showed that CRTS was associated with improved survival as compared with S (OR = 1.50 [95% CI 1.21 to 1.97]) and decreased occurrence of complications as compared with RTS (OR = 0.50 [95% CI 0.22 to 0.99]). Direct evidence revealed CRTS associated with improved survival (OR = 1.61 [95% CI 1.01 to 2.57]) and radical resection (OR = 4.01 [95% CI 1.66 to 9.69]) as compared with S. In terms of radical resection, CTS was more effective than S (OR = 1.73 [95% CI 1.09 to 2.76]). Findings for CTS and RTS did not differ for 5-year survival, operative mortality and postoperative complications.
  
  
  CONCLUSIONS
  Overall, CRTS might be the best choice for resectable ESCC because it could increase the radical resection rate and lower the occurrence of complications, thereby prolonging survival time.
authors.affiliation: Department of Public Health, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong, 515041, China. Electronic address: hywwell@126.com.
authors.forename: Yuanwei
authors.initials: Y
authors.lastname: Huang
authors.affiliation: School of Public Health, Tianjin Medical University, Tianjin, China. Electronic address: whd575545@126.com.
authors.forename: Haidong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Public Health, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong, 515041, China. Electronic address: luoganfeng1991@126.com.
authors.forename: Ganfeng
authors.initials: G
authors.lastname: Luo
authors.affiliation: Department of Public Health, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong, 515041, China. Electronic address: zhangyanting1992@126.com.
authors.forename: Yanting
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Public Health, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong, 515041, China. Electronic address: wangli3740@126.com.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Public Health, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong, 515041, China. Electronic address: keli1122@126.com.
authors.forename: Ke
authors.initials: K
authors.lastname: Li
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic
keywords: Esophageal squamous cell carcinoma; Neoadjuvant therapy; Network meta-analysis