Wu Qiangbin, Gao Wanpeng, Zhu Jiawang, Wang Qiang, Zhang Wei
Department of Emergency Medicine, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300150, China.
Department of Respiration Medicine, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300150, China.
Zhongguo Fei Ai Za Zhi. 2020 Dec 20;23(12):1066-1072. doi: 10.3779/j.issn.1009-3419.2020.101.50.
To compare the clinical efficacy of stereotactic body radiotherapy (SBRT) versus surgery for early-stage non-small cell lung cancer through evidence based medicine analysis.
A systematic search was performed in the PubMed, EMBASE, CNKI and Wan Fang databases to find studies published before June 2020. Two authors independently extracted the data and assessed the eligibility. All of the statistical analyses were performed using Stata 13.0. Subgroup analysis were performed according to the score matching study and operation type (lobectomy, segmentectomy and thoracoscopic assisted surgery).
Finally, 14 articles were included, including 15,841 cases in SBRT group and 17,708 cases in operation group. 10 articles used propensity score matching methods for survival analysis. Thirteen were retrospective cohort studies and one was randomized controlled trial. The results of meta-analysis showed that the overall survival rate of the surgery group and the SBRT group was statistically significant. The overall survival rate of the SBRT group (HR=1.51, 95%CI: 1.31-1.74) was inferior to that of the surgery group. In the subgroup analysis of the surgical type, there was no statistical difference between the SBRT group and each surgical type. The difference of overall survival rate between SBRT group and surgery group was statistically significant (HR=1.66, 95%CI: 1.45-1.90) in studies of propensity score matching. There was no statistically significant difference in cancer-specific survival between the surgery and SBRT groups (HR=1.12, 95%CI: 0.83-1.52).
The overall survival rate of surgical treatment is better than that of SBRT, but it has no obvious advantages in cancer specific survival rate.
通过循证医学分析比较立体定向体部放疗（SBRT）与手术治疗早期非小细胞肺癌的临床疗效。
在PubMed、EMBASE、CNKI和万方数据库中进行系统检索，以查找2020年6月之前发表的研究。两名作者独立提取数据并评估其合格性。所有统计分析均使用Stata 13.0进行。根据评分匹配研究和手术类型（肺叶切除术、肺段切除术和胸腔镜辅助手术）进行亚组分析。
最终纳入14篇文章，SBRT组15841例，手术组17708例。10篇文章采用倾向评分匹配法进行生存分析。13篇为回顾性队列研究，1篇为随机对照试验。Meta分析结果显示，手术组和SBRT组的总生存率有统计学意义。SBRT组的总生存率（HR=1.51，95%CI：1.31-1.74）低于手术组。在手术类型的亚组分析中，SBRT组与各手术类型之间无统计学差异。在倾向评分匹配研究中，SBRT组与手术组的总生存率差异有统计学意义（HR=1.66，95%CI：1.45-1.90）。手术组和SBRT组的癌症特异性生存率无统计学差异（HR=1.12，95%CI：0.83-1.52）。
手术治疗的总生存率优于SBRT，但在癌症特异性生存率方面无明显优势。
