Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 2018 May 1;101(1):186-194. doi: 10.1016/j.ijrobp.2018.01.064. Epub 2018 Feb 3.
As no completed randomized trials of surgery versus stereotactic ablative radiation therapy (SABR) in patients with early-stage non-small cell lung cancer are available, numerous propensity score studies have attempted to mimic the setting of clinical trials using nonrandomized data. We performed a meta-analysis of propensity score studies comparing SABR and surgery.
The MEDLINE and Embase databases were queried up to December 2016. Two authors independently reviewed the records for inclusion and extracted outcome measures. The study was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. The primary meta-analysis and secondary analyses were carried out using R (version 3.3.2) at a significance level of .05.
Sixteen studies were included in the meta-analysis. Overall survival favored surgery (hazard ratio for SABR vs surgery, 1.48 [95% confidence interval, 1.26-1.72]; I = 80.5%). Lung cancer-specific survival was not significantly different between SABR and surgery (hazard ratio, 1.17 [95% confidence interval, 0.92-1.50]; I = 18.6%). On stratification, overall survival favored both lobectomy and sublobar resection over SABR, although lung cancer-specific survival was again not significantly different. On secondary analysis, the lymph node upstaging rate was 15.6% following surgery, with 11.4% of patients receiving chemotherapy. The propensity score-matching caliper distance and first-author specialty were found to be associated with survival endpoints on regression.
For patients with early-stage non-small cell lung cancer who are eligible for either treatment, better overall survival was seen after surgery compared with SABR. However, lung cancer-specific survival was similar for both treatments. Prospective clinical trials are preferred to propensity analyses in evaluating the nature of non-cancer-related death after SABR.
由于目前尚无早期非小细胞肺癌患者手术与立体定向消融放疗（SABR）的随机临床试验，因此许多倾向评分研究试图使用非随机数据模拟临床试验的环境。我们对比较 SABR 和手术的倾向评分研究进行了荟萃分析。
我们在 MEDLINE 和 Embase 数据库中进行了检索，检索时间截至 2016 年 12 月。两位作者独立审查了纳入的记录并提取了结局指标。该研究按照 PRISMA（系统评价和荟萃分析的首选报告项目）和 MOOSE（观察性研究的荟萃分析流行病学）指南进行。主要荟萃分析和次要分析均在显著水平为.05 时使用 R（版本 3.3.2）进行。
荟萃分析纳入了 16 项研究。总体生存率有利于手术（SABR 与手术的风险比，1.48 [95%置信区间，1.26-1.72]；I = 80.5%）。SABR 与手术的肺癌特异性生存率无显著差异（风险比，1.17 [95%置信区间，0.92-1.50]；I = 18.6%）。分层后，肺叶切除术和亚肺叶切除术均优于 SABR，尽管肺癌特异性生存率无显著差异。在次要分析中，手术后淋巴结分期率为 15.6%，11.4%的患者接受了化疗。回归分析发现，倾向评分匹配卡尺距离和第一作者专业与生存终点有关。
对于有资格接受两种治疗的早期非小细胞肺癌患者，手术的总体生存率优于 SABR。然而，两种治疗的肺癌特异性生存率相似。在评估 SABR 后非癌症相关死亡的性质方面，倾向评分分析不如前瞻性临床试验。
