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Multimodal treatments for resectable esophagogastric junction cancer: A Bayesian network meta-analysis

Pengfei Shao1, Shazhen Nima1, Yang Tse1

  • 1Gastroenterology Department, Lhasa People's Hospital, No.1 Beijing East Road, Chengguan District, Lhasa, 850000, Tibet Autonomous Region, China.

Langenbeck'S Archives of Surgery
|March 19, 2023
PubMed
Abstract

Insights

Perioperative chemoradiotherapy (pCRT) shows promise for resectable esophagogastric junction cancer, offering the best outcomes for survival and reducing recurrence. This multimodal approach is recommended for optimal patient care.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Esophagogastric junction (EGJ) cancer requires optimal multimodal treatment strategies.
  • Evaluating various treatment modalities is crucial for improving patient survival and reducing recurrence.

Approach:

  • A systematic review and meta-analysis of 23 studies involving 18,319 patients with resectable EGJ cancer.
  • Network meta-analysis was employed to compare six different treatment strategies: surgery alone, neoadjuvant chemotherapy, perioperative chemotherapy, adjuvant chemotherapy, neoadjuvant chemoradiotherapy, and perioperative chemoradiotherapy.
  • Outcomes assessed included overall survival, locoregional recurrence, distant recurrence, and R0 resection rates.

Key Points:

  • Perioperative chemoradiotherapy (pCRT) demonstrated the highest probability of being the optimal treatment for overall survival (36.03%).
  • pCRT significantly reduced locoregional recurrence compared to other treatments, with the highest likelihood (68.86%) of achieving the lowest incidence.
  • Neoadjuvant chemoradiotherapy (nCRT) was associated with a significantly increased R0 resection rate (97.68% probability of being the best therapy).

Conclusions:

  • Perioperative chemoradiotherapy (pCRT) emerges as a potentially optimal multimodal treatment for resectable EGJ cancer, balancing survival and recurrence control.
  • While pCRT shows benefits for survival and locoregional recurrence, nCRT offers advantages in achieving complete tumor resection (R0).
  • Further research may refine treatment selection based on specific patient and tumor characteristics to optimize outcomes for EGJ cancer.
Keywords:
Multimodal treatmentsNetwork meta-analysisResectable esophagogastric junction cancer

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