Lu Di, Wang Zhizhi, Liu Xiguang, Feng Siyang, Dong Xiaoying, Shi Xiaoshun, Wang He, Wu Hua, Xiong Gang, Wang Haofei, Cai Kaican
Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,
Cancer Manag Res. 2019 Apr 2;11:2677-2690. doi: 10.2147/CMAR.S187940. eCollection 2019.
A survival improvement was achieved with adjuvant chemotherapy in non-small-cell lung cancer (NSCLC) patients, but its differential effects among patients with different stages remained controversial. This study aimed to compare the beneficial effects of adjuvant tyrosine kinase inhibitor (TKI) therapy with those of traditional therapy on NSCLC patients, specifically on EGFR-mutant and stage II-IIIA patients, who might benefit most from such treatment.
MEDLINE, Embase, and the Cochrane Library were searched, and the results were screened independently according to certain criteria by two authors. Disease-free survival (DFS) and overall survival (OS) with HRs were used as the summary statistics.
A total of 2,915 publications were identified and screened. Six randomized control trials and three retrospective cohort studies of 2,467 patients with acceptable quality were included. The overall EGFR mutation rate was 48.62%. DFS was significantly improved in all the patients (HR, 0.77; 95% CI, 0.68-0.88) and in the subgroup of EGFR-mutant patients (HR, 0.49; 95% CI, 0.40-0.61). The difference of 5-year OS in the subgroup of EGFR-mutant patients (HR, 0.48; 95% CI, 0.31-0.72) was statistically significant, while in all the patients (HR, 1.01; 95% CI, 0.85-1.19), the difference was not significant. In the subgroups of studies in which <50% of patients were in stage I (HR, 0.46; 95% CI, 0.35-0.60) and >30% of patients were in stage IIIA (HR, 0.46; 95% CI, 0.35-0.60), DFS was significantly improved, while in the subgroups of studies in which <30% of patients were in stage IIIA (HR, 0.90; 95% CI, 0.77-1.04) and >50% of patients were in stage I (HR, 0.90; 95% CI, 0.77-1.04), DFS was not significantly improved.
Stage IIIA NSCLC patients might benefit more from adjuvant TKIs than stage I NSCLC patients after radical resection.
辅助化疗可改善非小细胞肺癌（NSCLC）患者的生存率，但其在不同分期患者中的差异效应仍存在争议。本研究旨在比较辅助酪氨酸激酶抑制剂（TKI）治疗与传统治疗对NSCLC患者，特别是对EGFR突变型和II-IIIA期患者（可能从这种治疗中获益最大）的有益效果。
检索MEDLINE、Embase和Cochrane图书馆，并由两位作者根据特定标准独立筛选结果。无病生存期（DFS）和总生存期（OS）及风险比（HRs）用作汇总统计量。
共识别并筛选出2915篇出版物。纳入了6项随机对照试验和3项回顾性队列研究，共2467例质量可接受的患者。总体EGFR突变率为48.62%。所有患者的DFS均显著改善（HR，0.77；95%CI，0.68-0.88），EGFR突变型患者亚组也是如此（HR，0.49；95%CI，0.40-0.61）。EGFR突变型患者亚组的5年OS差异有统计学意义（HR，0.48；95%CI，0.31-0.72），而所有患者的差异无统计学意义（HR，1.01；95%CI，0.85-1.19）。在患者中<50%为I期（HR，0.46；95%CI，0.35-0.60）且>30%为IIIA期的研究亚组中，DFS显著改善，而在患者中<30%为IIIA期（HR，0.90；95%CI，0.77-1.04）且>50%为I期的研究亚组中，DFS未显著改善。
根治性切除术后，IIIA期NSCLC患者可能比I期NSCLC患者从辅助TKI治疗中获益更多。
