Comparison of Efficacy and Safety of Taxanes Plus Platinum and Fluorouracil Plus Platinum in the First-Line Treatment of Esophageal Cancer: A Systematic Review and Meta-Analysis

Round 1

Reviewer 1 Report

The authors found that EC patients undergoing dCRT benefited more from TP than FP regimen. In the lines 148-150: A total of 13 studies reported 3-year OS in EC patients treated with dCRT. The summary results showed that 3-year OS of TP group was better than that of FP group (RR: 1.25, 95% CI: 1.08-1.44, P = 0.003), and there was no heterogeneity in this result (I²= 24%, P = 0.21, Figure 3a). It is well known that patients with esophageal SCC benefited more from carbo/taxol (TP) when compared with patients with adenocarcinoma. So histology subtype is an important prognostic factor. There are total of 12 studies in figure 3a, 10 out of 12 studies are SCC cases, and only 2 out of 12 studies are the mixture of SCC and adenocarcinoma. Therefore, the meta-analysis for figure 3a is predominantly SCC. The conclusion for this figure 3a needs to be clarified if patients with adenocarcinoma also benefit more from TP group than FP group in dCRT setting. In line 155-163, analysis on 3-year PFS and ORR from figure 3b and 3c is also based on SCC predominant cases.

The authors found that TP and FP regimens had similar survival efficacy in EC patients treated with nCRT. In this analysis, 8/16 trials were the mixture of SCC and AC cases. The results showed that no difference was found in 3-year PFS between TP and PF groups (RR: 0.99, 95% CI: 0.86-1.13, P = 0.84, Figure 4d). Also, pCR in FP group was better than that in TP group (RR: 0.81, 95% CI: 0.68-0.96, P = 0.02).

Please address the histology subtypes in the dCRT and nCRT groups. 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Because the importance of chemoradiotherapy for esophageal cancer is increasing in the definitive and neoadjuvant settings, this issue is important. This reviewer’s concerns are followed.

 

Major

1.     In table 1, to include study types (retrospective, prospective, or RCT), 3-year OS and PFS rates for each chemotherapy regimen groups, and their p values would be better.

2.     The forest plots in Figures 3, 4, 6, and 7 are too small to see well.

3.     It was described that OS and PFS of TP group were better than those of FP group. However, in figure 3, OS and PFS were favored to FP group.

 

Minor

 

1.     On line 40, does medium mean middle thoracic? 

2.     For abbreviation of 5-fluoropyrimidine plus platinum, PF and FP were used. 

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Please correct minor grammar mistakes. 

Reviewer 2 Report

No further concern