Evaluation of neoadjuvant immunotherapy and traditional neoadjuvant therapy for resectable esophageal cancer: a systematic review and single-arm and network meta-analysis

Abstract

ObjectiveThis systematic review and meta-analysis aimed to investigate the role of neoadjuvant immunochemotherapy with or without radiotherapy [NIC(R)T] compared to traditional neoadjuvant therapies, without immunotherapy [NC(R)T].Summary background dataNCRT followed by surgical resection is recommended for patients with early-stage esophageal cancer. However, it is uncertain whether adding immunotherapy to preoperative neoadjuvant therapy would improve patient outcomes when radical surgery is performed following neoadjuvant therapy.MethodsWe searched PubMed, Web of Science, Embase, and Cochrane Central databases, as well as international conference abstracts. Outcomes included R0, pathological complete response (pCR), major pathological response (mPR), overall survival (OS) and disease-free survival (DFS) rates.ResultsWe included data from 5,034 patients from 86 studies published between 2019 and 2022. We found no significant differences between NICRT and NCRT in pCR or mPR rates. Both were better than NICT, with NCT showing the lowest response rate. Neoadjuvant immunotherapy has a significant advantage over traditional neoadjuvant therapy in terms of 1-year OS and DFS, with NICT having better outcomes than any of the other three treatments. There were no significant differences among the four neoadjuvant treatments in terms of R0 rates.ConclusionsAmong the four neoadjuvant treatment modalities, NICRT and NCRT had the highest pCR and mPR rates. There were no significant differences in the R0 rates among the four treatments. Adding immunotherapy to neoadjuvant therapy improved 1-year OS and DFS, with NICT having the highest rates compared to the other three modalities.Systematic Review Registrationhttps://inplasy.com/inplasy-2022-12-0060/, identifier INPLASY2022120060.

Neoadjuvant chemoradiotherapy combined with sequential perioperative toripalimab in locally advanced esophageal squamous cell cancer

“…8 17 Another systematic review and network meta-analysis demonstrated that there were no significant differences between NICRT and NCRT with regard to pCR or mPR rates, and both were superior to NICT. 24 Further randomized controlled studies are required to validate whether the tricombination neoadjuvant therapy approach yields a superior pathological response compared with standard nCRT. The ultimate objective of improving pCR is to provide survival benefits to patients.…”

Prognostic role of lymph node micrometastasis in pN0 esophageal cancer: A meta-analysis

“…[ 3 ] Although most patients with early and intermediate-stage esophageal cancer receive the systemic surgical and neoadjuvant/adjuvant therapies, a considerable proportion of esophageal cancer patients will still experience the recurrence and metastasis after the surgery, even among patients without lymph node metastasis. [ 4 , 5 ] Therefore, the causes and mechanisms of postoperative recurrence and metastasis in esophageal carcinoma patients need to be further investigated.…”