. Departamento de Imagens Médicas, Oncologia e Hematologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP - Ribeirão Preto (SP) Brasil.
. Departamento de Radioterapia, Américas Centro de Oncologia Integrado, Rio de Janeiro (RJ) Brasil.
J Bras Pneumol. 2022 Apr 29;48(3):e20210390. doi: 10.36416/1806-3756/e20210390. eCollection 2022.
To evaluate the efficacy of stereotactic body radiotherapy (SBRT) versus surgery for early-stage non-small cell lung cancer (NSCLC) by means of a meta-analysis of comparative studies.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, searches were performed on PubMed, MEDLINE, Embase, and Cochrane Library for eligible studies. The meta-analysis compared the hazard ratios (HR) for overall survival (OS), cancer-specific survival (CSS), and local control (LC). Subgroup and meta-regression analyses evaluated the association of extent of surgical resection, study publication year, tumor staging, propensity score matching, proportion of chemotherapy use, and proportion of pathological lymph node involvement with CSS and OS.
Thirty studies involving 29,511 patients were included (surgery group: 17,146 patients and SBRT group: 12,365 patients). There was a significant difference in favor of surgery vs. SBRT in the 3-year OS (HR = 1.35; 95% CI: 1.22-1.44; I2 = 66%) and 3-year CSS (HR = 1.23; 95% CI: 1.09-1.37; I2 = 17%), but not in the 3-year LC (HR = 0.97; 95% CI: 0.93-1.08; I2 = 19%). In the subgroup analysis for OS, no significant difference between surgery and SBRT groups was observed in the T1N0M0 subgroup (HR = 1.26; 95% CI: 0.95-1.68; I2 = 0%). In subgroup analysis for CSS, no significant difference was detected between the sublobar resection subgroup and the SBRT group (HR = 1.21; 95% CI: 0.96-1.53; I2 = 16%).
Surgery generally resulted in better 3-year OS and CSS than did SBRT; however, publication bias and heterogeneity may have influenced these findings. In contrast, SBRT produced LC results similar to those of surgery regardless of the extent of surgical resection. These findings may have important clinical implications for patients with comorbidities, advanced age, poor pulmonary reserve, and other factors that may contraindicate surgery.
通过对比较研究的荟萃分析，评估立体定向体放射治疗（SBRT）与手术治疗早期非小细胞肺癌（NSCLC）的疗效。
根据系统评价和荟萃分析的首选报告项目以及观察性研究荟萃分析的指南，在 PubMed、MEDLINE、Embase 和 Cochrane Library 上进行了检索，以获取符合条件的研究。荟萃分析比较了总生存（OS）、癌症特异性生存（CSS）和局部控制（LC）的风险比（HR）。亚组和荟萃回归分析评估了手术切除范围、研究发表年份、肿瘤分期、倾向评分匹配、化疗使用率和病理性淋巴结受累比例与 CSS 和 OS 的相关性。
共纳入 30 项研究，涉及 29511 例患者（手术组：17146 例，SBRT 组：12365 例）。手术组与 SBRT 组在 3 年 OS（HR=1.35；95%CI：1.22-1.44；I2=66%）和 3 年 CSS（HR=1.23；95%CI：1.09-1.37；I2=17%）方面存在显著差异，但在 3 年 LC（HR=0.97；95%CI：0.93-1.08；I2=19%）方面无显著差异。在 OS 的亚组分析中，在 T1N0M0 亚组中，手术组与 SBRT 组之间无显著差异（HR=1.26；95%CI：0.95-1.68；I2=0%）。在 CSS 的亚组分析中，亚肺叶切除术亚组与 SBRT 组之间未发现显著差异（HR=1.21；95%CI：0.96-1.53；I2=16%）。
手术组的 3 年 OS 和 CSS 总体优于 SBRT 组；然而，发表偏倚和异质性可能影响了这些发现。相比之下，SBRT 的 LC 结果与手术相似，无论手术切除范围如何。这些发现对于因合并症、高龄、肺储备功能差等因素而不能手术的患者可能具有重要的临床意义。
