术后放疗对完全切除且经病理证实为N2期非小细胞肺癌患者生存的影响：一项系统评价和荟萃分析。
Effect of postoperative radiotherapy on survival in patients with completely resected and pathologically confirmed stage N2 non-small-cell lung cancer: a systematic review and meta-analysis.
作者信息
Wang Lin, Chen Wenyu, Xu Xiaofei, Chen Wenbo, Bao Derong, Zhang Ye, Xu Yufen
机构信息
Department of Oncology, Affiliated Hospital of Jiaxing University, Jiaxing, China.
Department of Respiratory Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, China.
出版信息
Ther Adv Chronic Dis. 2023 Sep 13;14:20406223231195622. doi: 10.1177/20406223231195622. eCollection 2023.
BACKGROUND
The role of postoperative radiotherapy (PORT) for patients with completely resected stage N2 non-small-cell lung cancer (NSCLC) has been controversial. This study aimed to investigate the efficacy of PORT and prognosis in these patients.
OBJECTIVES
An updated meta-analysis was conducted in this study to investigate the efficacy of PORT and prognosis in patients with completely resected and pathologically confirmed stage N2 NSCLC.
DESIGN
This study is a systematic review and meta-analysis.
DATA SOURCE AND METHODS
Databases were searched up to 2 March 2022. All trials on patients with completely resected and pathologically confirmed stage N2 NSCLC undergoing PORT were screened, and data indicators in the PORT and non-PORT groups were extracted, respectively. The effect of PORT on overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) was estimated. Subgroup and sensitivity analyses were performed.
RESULTS
In all, 20 studies involving 6340 patients were finally included. The PORT significantly increased OS [hazard ratio (HR) = 0.77, 95% CI: 0.71-0.84, < 0.001), LRFS (HR = 0.63, 95% CI: 0.52-0.76, < 0.001), and DFS (HR = 0.72, 95% CI: 0.63-0.82, < 0.001) while it showed no significant difference in improving DMFS (HR = 0.86, 95% CI: 0.71-1.05, = 0.14).
CONCLUSION
Our results suggest that in the postoperative treatment of patients with completely resected and pathologically confirmed stage N2 NSCLC, the addition of PORT provides better local recurrence control and survival benefit, but no benefit for distant metastases. The PORT may be incorporated into the postoperative treatment options for some patients with high-risk factors. However, it needs to be validated by more prospective studies in the future.
TRAIL REGISTRATION
CRD42022314095.
背景
术后放疗（PORT）对完全切除的N2期非小细胞肺癌（NSCLC）患者的作用一直存在争议。本研究旨在探讨PORT对这些患者的疗效及预后。
目的
本研究进行了一项更新的荟萃分析，以探讨PORT对完全切除且经病理证实为N2期NSCLC患者的疗效及预后。
设计
本研究为系统评价和荟萃分析。
数据来源与方法
检索数据库至2022年3月2日。筛选所有关于完全切除且经病理证实为N2期NSCLC患者接受PORT的试验，并分别提取PORT组和非PORT组的数据指标。评估PORT对总生存期（OS）、无病生存期（DFS）、无局部复发生存期（LRFS）和无远处转移生存期（DMFS）的影响。进行亚组分析和敏感性分析。
结果
最终纳入20项研究，共6340例患者。PORT显著提高了OS[风险比（HR）=0.77，95%置信区间（CI）：0.71-0.84，P<0.001]、LRFS（HR=0.63，95%CI：0.52-0.76，P<0.001）和DFS（HR=0.72，95%CI：0.63-0.82，P<0.001），而在改善DMFS方面无显著差异（HR=0.86，95%CI：0.71-1.05，P=0.14）。
结论
我们的结果表明，在完全切除且经病理证实为N2期NSCLC患者的术后治疗中，加用PORT可提供更好的局部复发控制和生存获益，但对远处转移无益处。PORT可纳入部分有高危因素患者的术后治疗选择。然而，未来需要更多前瞻性研究进行验证。
试验注册
CRD42022314095。
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