Summary of findings for the main comparison. Chemoradiotherapy versus chemoradiotherapy plus surgery for esophageal cancer.
| Chemoradiotherapy versus chemoradiotherapy plus surgery for esophageal cancer | |||||
| Patient or population: nonmetastatic esophageal cancer Setting: hospital Intervention: chemoradiotherapy plus surgery Comparison: chemoradiotherapy alone | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with chemoradiotherapy alone | Risk with chemoradiotherapy plus surgery | ||||
| Overall survival Follow‐up: median 4 to 6 years | 35.4% to 40.0% at 2 years | 34.0% to 39.9% at 2 years | HR 0.99 (95% CI 0.79 to 1.24) | 431 (2 RCTs) | ⊕⊕⊕⊕ High |
| Freedom from locoregional relapse Follow‐up: median 4 to 6 years |
40.7% to 57.0% at 2 years | 64.3% to 66.4% at 2 years | HR 0.55 (95% CI 0.39 to 0.76) | 431 (2 RCTs) | ⊕⊕⊕⊝ Moderate1 |
| Quality of Life assessed with: Spitzer QoL index Scale: 0 to10 Follow‐up: 3 months |
the mean Q0L score was 7.52 points in the chemoradiotherapy alone group | the mean QoL score in the chemoradiotherapy plus surgery group was 0.93 points worse (from ‐1.62 worse to ‐0.24 worse) | 165 (1 RCT) |
⊕⊝⊝⊝ Very Low2,3,4 | |
| Treatment‐related mortality Follow‐up: median 1 to 3 months |
1.9 per 100 | 9.5 per 100 (3.2 to 27.8) |
RR 5.11 (95% CI 1.74 to 15.02) | 431 (2 RCTs) | ⊕⊕⊝⊝ Low1,2 |
| Use of salvage procedures for dysphagia Follow‐up: median 4 years |
46 per 100 | 24 per 100 | RR 0.52 (95% CI 0.36 to 0.75) | 259 (1 RCT) |
⊕⊕⊝⊝ Low1,2 |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; HR: Hazard ratio; | |||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | |||||
1 Downgraded one level due to risk of bias (detection bias as investigators were not blinded). 2 Downgraded one level due to imprecision. 3 Downgraded two levels due to risk of bias (detection bias as investigators and participants were not blinded).