Xu Ya-Ping, Li Bo, Xu Xiao-Ling, Mao Wei-Min
From the Department of Radiation Oncology (Y-PX); Zhejiang Cancer Research Institute (BL, X-LX); and Department of Thoracic Surgery (W-MM), Zhejiang Cancer Hospital, Hangzhou, China.
Medicine (Baltimore). 2015 Jun;94(23):e879. doi: 10.1097/MD.0000000000000879.
Optimal management of clinical stage IIIA (N2) non-small cell lung cancer (NSCLC) is controversial. This study is a systematic review and meta-analysis of published randomized control trials of multimodality management strategies for NSCLC. We conducted a comprehensive literature search of the Pubmed, Embase, Medline, and CENTRAL databases for relevant studies comparing patients with stage IIIA (N2) NSCLC undergoing surgery alone, chemotherapy and/or radiotherapy alone, or surgical resection after neoadjuvant treatment with chemotherapy and/or radiotherapy. We estimated hazard ratios, odds ratios (ORs), and 95% confidence intervals (CIs) for survival data. Seven trials involving 1049 patients were included in this study. There was no significant difference in overall survival (OS) or progression-free survival (PFS) in stage IIIA (N2) NSCLC patients who received neoadjuvant chemotherapy or chemoradiotherapy prior to surgical resection compared to those who received neoadjuvant chemotherapy or chemoradiotherapy prior to radical radiotherapy. There was a significant increase in pathological complete remission in the mediastinal lymph nodes in stage IIIA (N2) NSCLC patients who received neoadjuvant chemoradiotherapy prior to surgical resection compared to those who received neoadjuvant chemotherapy (OR 3.61; 95% CI 1.07-12.15; P = 0.04), but no difference in tumor downstaging, OS, or PFS. Neoadjuvant chemotherapy and/or radiotherapy prior to surgical resection do not appear to be clinically superior to neoadjuvant chemotherapy and/or radiotherapy prior to definitive radiotherapy in IIIA (N2) NSCLC patients. Neoadjuvant chemoradiotherapy does not improve survival compared to neoadjuvant chemotherapy alone.
临床 IIIA 期（N2）非小细胞肺癌（NSCLC）的最佳治疗方案存在争议。本研究是对已发表的 NSCLC 多模式治疗策略随机对照试验的系统评价和荟萃分析。我们对 Pubmed、Embase、Medline 和 CENTRAL 数据库进行了全面的文献检索，以查找相关研究，比较单独接受手术、单独接受化疗和/或放疗，或在新辅助化疗和/或放疗后进行手术切除的 IIIA 期（N2）NSCLC 患者。我们估计了生存数据的风险比、比值比（OR）和 95%置信区间（CI）。本研究纳入了 7 项涉及 1049 名患者的试验。与在根治性放疗前接受新辅助化疗或放化疗的患者相比，在手术切除前接受新辅助化疗或放化疗的 IIIA 期（N2）NSCLC 患者的总生存期（OS）或无进展生存期（PFS）没有显著差异。与接受新辅助化疗的患者相比，在手术切除前接受新辅助放化疗的 IIIA 期（N2）NSCLC 患者纵隔淋巴结的病理完全缓解率显著提高（OR 3.61；95%CI 1.07 - 12.15；P = 0.04），但在肿瘤降期、OS 或 PFS 方面没有差异。在 IIIA 期（N2）NSCLC 患者中，手术切除前的新辅助化疗和/或放疗在临床上似乎并不优于根治性放疗前的新辅助化疗和/或放疗。与单纯新辅助化疗相比，新辅助放化疗并不能提高生存率。
