Neoadjuvant immunochemoradiotherapy versus chemoradiotherapy in esophageal cancer: a systematic review and meta-analysis of reconstructed individual patient data
Abstract
PURPOSE
Neoadjuvant immunochemoradiotherapy (nICRT) is emerging as a promising treatment for resectable esophageal cancer, but comprehensive analyses comparing it to standard neoadjuvant chemoradiotherapy (nCRT) are limited. This meta-analysis aimed to evaluate the efficacy, safety, and survival outcomes of nICRT versus nCRT.
METHODS AND MATERIALS
A systematic search of PubMed, Embase, the Cochrane Library, and major conference proceedings up to October 30, 2024, identified studies involving resectable esophageal cancer treated with nICRT or nCRT. Data on pathological complete response (pCR), major pathological response (MPR), treatment-related adverse events (TRAEs), overall survival (OS), and progression-free survival (PFS) were extracted. A one-stage meta-analysis using reconstructed individual patient data was performed, calculating hazard ratios (HRs) with 95% confidence intervals (CIs).
RESULTS
Thirty-seven studies were included, comprising 811 patients treated with nICRT and 1,796 with nCRT. nICRT demonstrated significantly longer OS than nCRT (HR = 0.714, 95% CI 0.550-0.926, p = 0.011). The 1-year, 2-year and 3-year OS rates were 89.9%, 76.0% and 66.4% for nICRT, compared to 85.0%, 66.5% and 57.3% for nCRT. The pCR rate was significantly higher in nICRT (50% vs. 38%; p = 0.040) for squamous cell carcinoma. Safety profiles were comparable, with no significant differences in grade 3-4 TRAEs or postoperative complications between the groups.
CONCLUSION
nICRT showed…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 811 participants or records.
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