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立体定向消融放疗与肺叶切除术治疗Ⅰ期非小细胞肺癌的系统评价

Stereotactic ablative radiotherapy versus lobectomy for stage I non-small cell lung cancer: A systematic review.

作者信息

Wang Siwei, Wang Xiaoxiao, Zhou Qing, Xu Youtao, Xia Wenjia, Xu Weizhang, Ma ZhiFei, Qiu Mantang, You Ran, Xu Lin, Yin Rong

机构信息

Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.

The Fourth Clinical College of Nanjing Medical University, Nanjing, China.

出版信息

Thorac Cancer. 2018 Mar;9(3):337-347. doi: 10.1111/1759-7714.12574. Epub 2018 Jan 11.

DOI:10.1111/1759-7714.12574
PMID:29322682
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5832478/
Abstract

BACKGROUND

There is debate regarding the use of stereotactic ablative radiotherapy (SABR) or surgery for patients with early stage non-small cell lung cancer (NSCLC). This meta-analysis compared the clinical efficacy of SABR and lobectomy in stage I NSCLC patients.

METHODS

An online search identified eight eligible articles (including 2 trials and 7 cohort studies) for inclusion. The odds ratio (OR) was used as a summary statistic. Overall survival (OS), cause-specific survival (CSS), and recurrence-free survival (RFS) were selected to calculate ORs with 95% confidence intervals (CI). Fixed-effects or random-effects models were conducted according to study heterogeneity.

RESULTS

There were no significant differences between SABR and lobectomy in terms of one-year OS or CSS. Significant benefits of surgery were observed in three-year OS (OR 2.11, 95% CI 1.55-2.86), three-year CSS (OR 1.94, 95% CI 1.05-3.57), three-year RFS (OR 1.63, 95% CI 1.12-2.36), and five-year OS (OR 2.40, 95% CI 1.71-3.36). In addition, lobectomy demonstrated a beneficial trend in one-year RFS, five-year RFS, and CSS.

CONCLUSION

Meta-analyses of current evidence suggested that lobectomy provides better long-term survival outcomes for stage I NSCLC patients.

摘要

背景

对于早期非小细胞肺癌（NSCLC）患者，立体定向消融放疗（SABR）或手术的应用存在争议。本荟萃分析比较了SABR与肺叶切除术在I期NSCLC患者中的临床疗效。

方法

通过在线检索确定了8篇符合纳入标准的文章（包括2项试验和7项队列研究）。采用比值比（OR）作为汇总统计量。选择总生存期（OS）、病因特异性生存期（CSS）和无复发生存期（RFS）来计算95%置信区间（CI）的OR值。根据研究异质性采用固定效应或随机效应模型。

结果

SABR与肺叶切除术在1年OS或CSS方面无显著差异。在3年OS（OR 2.11，95%CI 1.55 - 2.86）、3年CSS（OR 1.94，95%CI 1.05 - 3.57）、3年RFS（OR 1.63，95%CI 1.12 - 2.36）和5年OS（OR 2.40，95%CI 1.71 - 3.36）方面观察到手术有显著益处。此外，肺叶切除术在1年RFS、5年RFS和CSS方面显示出有益趋势。

结论

对现有证据的荟萃分析表明，肺叶切除术为I期NSCLC患者提供了更好的长期生存结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/8a35c3bc8f57/TCA-9-337-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/b3a2cd95eaa2/TCA-9-337-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/cce9ad2adc18/TCA-9-337-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/09a39d2e8e70/TCA-9-337-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/8a35c3bc8f57/TCA-9-337-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/b3a2cd95eaa2/TCA-9-337-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/cce9ad2adc18/TCA-9-337-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/09a39d2e8e70/TCA-9-337-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b68a/5832478/8a35c3bc8f57/TCA-9-337-g004.jpg

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