Survival Advantage of Conversion Surgery Following Induction Therapy in cT4 Esophageal Cancer: A Systematic Review and Meta-Analysis
A partir d'une revue systématique de la littérature publiée jusqu'au 31 janvier 2025 (17 études, 3 721 patients), cette méta-analyse évalue la survie lors d'une chirurgie de conversion après traitement d'induction par rapport à une chimioradiothérapie exclusive pour des patients atteints d'un cancer de l'oesophage de stade cT4
Background: cT4 esophageal cancer represents a major therapeutic challenge, with definitive chemoradiotherapy (dCRT) currently considered the standard treatment. However, survival outcomes remain unsatisfactory. CS following induction therapy has emerged as a potential alternative strategy, though its clinical effectiveness remains under debate. This systematic review and meta-analysis aimed to compare survival outcomes between conversion surgery (CS) and definitive therapy in patients with cT4 esophageal cancer.
Methods: Relevant literature was retrieved from PubMed, the Cochrane Library, and Embase. Patients were categorized into the CS group or the definitive therapy group. A systematic review and meta-analysis were performed to evaluate 1-, 3-, and 5-year overall survival (OS) outcomes in patients with esophageal cancer. Odds ratios, mean differences, and 95% confidence intervals were calculated using fixed-effects or random-effects models.
Results: Seventeen studies involving a total of 3721 patients with cT4 esophageal cancer were included. After excluding studies with high heterogeneity, CS was associated with significantly better survival compared to definitive therapy at 1-year (73.6% vs. 49.6%), 3-year (37.0% vs. 18.4%), and 5-year (26.5% vs. 11.6%) OS. A subgroup analysis of three studies including 341 patients with cT4b disease revealed a significant survival advantage for the CS group in both 1-year OS (86.4% vs. 37.6%) and 3-year OS (48.6% vs. 11.4%).
Conclusions: CS following induction therapy significantly improves survival in patients with cT4 esophageal cancer. However, the survival benefit of CS for cT4b disease requires further validation in larger prospective studies.
European Journal of Surgical Oncology , résumé, 2026