Department of Radiation Oncology, Ansan Hospital, Gyeonggi-do.
Samsung Medical Center, Sungkyunkwan University School of Medicine.
Int J Surg. 2023 Apr 1;109(4):1006-1014. doi: 10.1097/JS9.0000000000000339.
This meta-analysis analyzed the oncologic role of local ablative treatment (LAT) in oligometastatic nonsmall cell lung cancer.
Pubmed, MEDLINE, Embase, and Cochrane Library were searched until October, 2022. Studies comparing LAT with standard care (control) were included. Sensitivity analyses were performed including randomized controlled studies (RCTs). Subgroup analyses were performed according to specific categories and metastatic burden. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Considering the median OS and PFS from landmark studies, 2-year OS and 1-year PFS rates were used to calculate pooled odds ratios (ORs).
A total of 20 studies (four RCTs) encompassing 1750 patients were included. Surgery and radiotherapy (60 and 90% of studies) were mainly used as LATs. Pooled ORs of OS and PFS were 3.492 (95% CI:2.612-4.699, P <0.001) and 3.743 (95% CI: 2.586-5.419, P <0.001), favoring LAT, respectively. Sensitivity analyses, including RCTs showed ORs of 4.111 ( P <0.001) and 4.959 ( P =0.001) regarding OS and PFS, favoring LCT, respectively. Pooled 1-year and 2-year OS rates were 83.8 and 58.4% in LAT arms, whereas 64.4 and 31% in control arms; pooled 1-year and 2-year PFS rates were 64.6 and 32.8% in LAT arms, and 36.1 and 10% in control arms. In subgroup analyses, the pooled ORs were 3.981 ( P <0.001), 3.355 ( P <0.001), and 1.726 ( P =0.373) in synchronous, oligopersistence, and oligoprogression/recurrence subgroups, respectively. Regarding PFS comparison, pooled ORs were 5.631 ( P <0.001), 3.484 ( P <0.001), and 1.777 ( P =0.07), respectively. According to metastatic burden categories, pooled ORs favored LAT arms in both analyses including low-metastatic and high-metastatic burden subgroups.
The present study supports the role of LAT in treating nonsmall cell lung cancer oligometastasis. The oligoprogression/recurrence disease could have less LAT benefit than synchronous or oligopersistent disease.
本荟萃分析分析了局部消融治疗（LAT）在寡转移性非小细胞肺癌中的肿瘤学作用。
检索 PubMed、MEDLINE、Embase 和 Cochrane 图书馆，检索时间截至 2022 年 10 月。纳入比较 LAT 与标准治疗（对照组）的研究。进行了包括随机对照研究（RCT）的敏感性分析。根据具体类别和转移负担进行亚组分析。主要终点为总生存期（OS）和无进展生存期（PFS）。考虑到标志性研究的中位 OS 和 PFS，使用 2 年 OS 和 1 年 PFS 率来计算汇总优势比（OR）。
共纳入 20 项研究（4 项 RCT），包括 1750 名患者。手术和放疗（60%和 90%的研究）主要用作 LAT。OS 和 PFS 的汇总 OR 分别为 3.492（95%CI：2.612-4.699，P<0.001）和 3.743（95%CI：2.586-5.419，P<0.001），有利于 LAT。包括 RCT 在内的敏感性分析显示 OS 和 PFS 的 OR 分别为 4.111（P<0.001）和 4.959（P=0.001），有利于 LCT。LAT 组的 1 年和 2 年 OS 率分别为 83.8%和 58.4%，对照组分别为 64.4%和 31%；LAT 组的 1 年和 2 年 PFS 率分别为 64.6%和 32.8%，对照组分别为 36.1%和 10%。在亚组分析中，同步、寡存继和寡进展/复发亚组的汇总 OR 分别为 3.981（P<0.001）、3.355（P<0.001）和 1.726（P=0.373）。对于 PFS 比较，汇总 OR 分别为 5.631（P<0.001）、3.484（P<0.001）和 1.777（P=0.07）。根据转移负担类别，在包括低转移和高转移负担亚组的两项分析中，汇总 OR 均有利于 LAT 组。
本研究支持 LAT 治疗非小细胞肺癌寡转移的作用。寡进展/复发疾病的 LAT 获益可能不如同步或寡存继疾病。
