Evidence map›Paper›PMID 32199464›Full record

SynthesisWorld journal of surgical oncology2020

Neoadjuvant strategies in resectable carcinoma esophagus: a meta-analysis of randomized trials.

Tarun Kumar, Esha Pai, Rajesh Singh, Neville J Francis, Manoj Pandey

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in World journal of surgical oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Tarun KumarDepartment of Surgical Oncology, Banaras Hindu University, Varanasi, 221005, India. batra_tarun@hotmail.com.
Esha PaiDepartment of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India.
Rajesh SinghDepartment of Surgical Oncology, Asian Institute of Oncology, Mumbai, 400022, India.
Neville J FrancisDepartment of Surgical Oncology, Banaras Hindu University, Varanasi, 221005, India.
Manoj PandeyDepartment of Surgical Oncology, Banaras Hindu University, Varanasi, 221005, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe survival benefit of neoadjuvant therapy in resectable carcinoma esophagus has been elucidated. We performed a meta-analysis in light of new studies and long-term results of past trials. The search strategy was refined to include only "neoadjuvant" so that any bias by adjuvant treatment is eliminated.

methodsA detailed search of MEDLINE, Embase, and Cochrane Library was done. Only published randomized English language trials were included. Data were categorized as neoadjuvant concurrent chemoradiation (NACRT), neoadjuvant chemotherapy (NACT), neoadjuvant radiotherapy (NART), and neoadjuvant sequential chemoradiotherapy (SCRT). Meta-analysis was done using odds ratio (OR) and 95% CI using fixed/random effects model. Heterogeneity was tested by chi-square and I

resultsTwenty-five randomized trials involving 5272 patients were included for quantitative analysis. NACRT was evaluated in 12 studies (2676 patients). Superior 3-year OS (OR = 0.68 CI 0.52-0.90, p = 0.007), 3-year DFS (OR = 0.55 CI 0.45-0.68, p = 0.00001), and 5-year DFS (OR = 0.59 CI 0.47-0.74, p = 0.00001), with lower failures (OR = 0.52 CI 0.37-0.73, p = 0.0001), were seen in favor of NACRT at the cost of increased perioperative mortality (OR = 1.79 CI 1.15-2.80, p = .01). However, 5-year OS (OR = 0.78 CI 0.60-0.1.01, p = 0.06) was not found to be significantly superior. NACT, NART, and SCRT were not found to have any benefit over surgery alone.

conclusionThis meta-analysis presents strong evidence favoring NACRT over upfront surgery. It also shows no survival advantage of neoadjuvant chemotherapy.

Indexed as

Disease-Free SurvivalEsophageal NeoplasmsEsophageal Squamous Cell CarcinomaEsophagectomyHumansNeoadjuvant TherapyRandomized Controlled Trials as TopicSurvival RateCarcinoma esophagusNeoadjuvant chemoradiationNeoadjuvant chemotherapyNeoadjuvant radiationPreoperative chemoradiationPreoperative chemotherapySequential chemoradiation

Identifiers

PMID32199464
PMCPMC7085863

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.