Objective To evaluated the efficacy and safety of chemotherapy followed by surgery(CS group) and surgery alone (S group) for esophageal cancer. Methods Esophageal cancer published RCTs were searched from pubmed, cochrance and Vip Date. RCTs were considered high quality if methodological quality score was 3 or more according Jadad standard. Statistical heterogeneity among these RCTs was evaluated by Revman5. 0. Heterogeneity of the included RCTs was tested which was used to select proper effect model to calculate. Publication bias was investigated through visual inspection of funnel plots. Results 11 RCTs included 2 911 cases with esophageal cancer were selected. Compared with surgery alone group,chemotherapy followed by surgery group significantly increased 3-year, 5-year overall survival rate of esophageal cancer. The odds ratio (OR) was 1.63(95 %CI: 1.27- 2.10 , P = 0. 000 2)for 3-year overall survival,1. 57(95%CI:1.31 - 1.88,P<0.000 01)for 5-year overall survival,and the total OR of postoperative complication in chemotherapy followed by surgery group was 1.01(95%CI:0. 85- 1.20,P = 0.91). Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias. Conclusion Neoadjuvant chemotherapy and surgery improves 3-year,5-year overall survival rate of esophageal cancer,but doesn t reduce the postoperative complication.%目的 评价新辅助化疗联合手术与单纯手术治疗食管癌的疗效和安全性.方法 检索PubMed、Cochrance图书馆、维普等数据库中近20年来食管癌治疗的随机对照试验(RCTs)的文献,将Jadad评分大于或等于3分高质量文章纳入本研究.数据分析采用Revman5.0软件,检验异质性,并根据其结果选择相应的效应模型,绘制漏斗图评定有无发表偏倚.结果 共11项RCTs、2 911例食管癌患者入选.与单纯手术组相比,新辅助化疗组能明显改善食管癌患者的预后,3年总体生存率的合并优势比(OR)为1.63,95%可信区间(95%CI)为1.27～2.10(P=0.000 2),5年总体生存率的OR为1.57,95%CI为1.31～1.88(P＜0.000 01);术后并发症的OR为1.01,95%CI为0.85～1.20(P=0.91).结论 新辅助化疗能明显提高食管癌患者的3、5年总体生存率,且不增加术后并发症的发生率.
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