Shen Ziyang, Lu Ya, Sui Ying, Feng Sitong, Feng Jifeng, Zhou Jinrong
Department of Malignant Lung Tumor Targeting Therapy Research Center, Jiangsu Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China.
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Clin Med Insights Oncol. 2022 Jul 12;16:11795549221109487. doi: 10.1177/11795549221109487. eCollection 2022.
The National Comprehensive Cancer Network (NCCN) guidelines did not give an explicit comparison of the efficacy between surgery and radiotherapy in treating Stage-III N2 non-small cell lung cancer (NSCLC) patients, leaving a paucity for clinical reference. Through this study, we try to locate the optimum treatment strategy including surgical type for these patients.
A systematic literature search was performed from PubMed, Cochrane Library, Embase, and Google Scholars. The endpoints were overall survival (OS), mean OS, and progression-free survival (PFS). The treatments comprised radiotherapy, lobectomy, and pneumonectomy. Network meta-analysis was carried out for calculating the odds ratio (OR) for binary variants. All the analyses implemented Stata 17.0 MP.
Eight clinical trials reporting 1756 patients met the inclusion criteria. Radiotherapy and surgery were equivalent in improving patients' OS (OR = 0.842, 95% confidence interval [CI]: [0.645, 1.099]). The mean OS of patients were similar in terms of radiotherapy, lobectomy, and pneumonectomy. Besides, radiotherapy and surgery had equivalent effects in improving PFS (OR = 0.896, 95% CI: [0.718, 1.117]).
Since lobectomy and pneumonectomy following neoadjuvant treatments had equivalent efficacy in prolonging OS for patients with stage-IIIA N2 NSCLC compared with definitive radiotherapy, young patients with favorable performance status (0) should try surgery to pursue better prognosis while elderly patients with unfavorable PS or radiosensitive pathology types should accept definitive radiotherapy. More high-quality clinical trials are needed to support our findings.
美国国立综合癌症网络（NCCN）指南未明确比较手术与放疗在治疗Ⅲ期N2非小细胞肺癌（NSCLC）患者中的疗效，缺乏临床参考依据。通过本研究，我们试图为这些患者确定最佳治疗策略，包括手术类型。
从PubMed、Cochrane图书馆、Embase和谷歌学术进行系统的文献检索。终点指标为总生存期（OS）、平均OS和无进展生存期（PFS）。治疗方法包括放疗、肺叶切除术和全肺切除术。进行网络荟萃分析以计算二元变量的比值比（OR）。所有分析均使用Stata 17.0 MP软件。
八项报告了1756例患者的临床试验符合纳入标准。放疗和手术在改善患者OS方面效果相当（OR = 0.842，95%置信区间[CI]：[0.645, 1.099]）。放疗、肺叶切除术和全肺切除术患者的平均OS相似。此外，放疗和手术在改善PFS方面效果相当（OR = 0.896，95% CI：[0.718, 1.117]）。
由于新辅助治疗后行肺叶切除术和全肺切除术与根治性放疗相比，在延长ⅢA期N2 NSCLC患者OS方面疗效相当，身体状况良好（0分）的年轻患者应尝试手术以追求更好的预后，而身体状况不佳或病理类型对放疗敏感的老年患者应接受根治性放疗。需要更多高质量的临床试验来支持我们的研究结果。
