Bin Sumaida Abdulrahman, Shanbhag Nandan M, Pervez Nadeem, AlKaabi Khalifa, Balaraj Khalid
Oncology/Radiation Oncolgy, Tawam Hospital, Al Ain, ARE.
Radiation Oncology/Palliative Care, Tawam Hospital, Al Ain, ARE.
Cureus. 2025 May 19;17(5):e84440. doi: 10.7759/cureus.84440. eCollection 2025 May.
This systematic review and meta-analysis aimed to compare the efficacy of stereotactic body radiotherapy (SBRT) and surgical resection in early-stage non-small cell lung cancer (NSCLC), focusing on overall survival (OS), cancer-specific survival (CSS), and local control (LC). A comprehensive literature search was conducted using PubMed, Cochrane Library, ScienceDirect, and Google Scholar, and eligible studies were selected according to PRISMA guidelines. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for OS, CSS, and LC using fixed- or random-effects models, and the Newcastle-Ottawa Scale was used to assess study quality. A total of 41 studies involving 88,228 patients (58,366 treated with surgery and 29,862 with SBRT) were included. Surgical resection was significantly associated with improved three-year OS (HR = 1.39; 95% CI: 1.25-1.55; p < 0.00001) compared to SBRT. Subgroup analysis revealed greater survival benefits with lobectomy (HR = 1.50; p < 0.00001) than sublobar resection (HR = 1.27; p = 0.002) or mixed approaches (HR = 1.39; p = 0.007). CSS also favored surgery (HR = 1.22; p = 0.006), particularly lobectomy (HR = 1.46; p = 0.002). LC was comparable between SBRT and surgery (HR = 0.92; p = 0.06), although lobectomy showed a slight advantage (HR = 0.92; p = 0.04). These findings suggest that surgical resection, especially lobectomy, offers superior OS and CSS compared to SBRT in early-stage NSCLC, while LC outcomes are generally equivalent. SBRT remains an effective alternative for medically inoperable patients; however, in operable candidates, surgery should be considered the preferred approach to maximize long-term outcomes.
本系统评价和荟萃分析旨在比较立体定向体部放疗（SBRT）与手术切除在早期非小细胞肺癌（NSCLC）中的疗效，重点关注总生存期（OS）、癌症特异性生存期（CSS）和局部控制（LC）。使用PubMed、Cochrane图书馆、ScienceDirect和谷歌学术进行了全面的文献检索，并根据PRISMA指南选择符合条件的研究。使用固定效应或随机效应模型计算OS、CSS和LC的合并风险比（HR）及95%置信区间（CI），并使用纽卡斯尔-渥太华量表评估研究质量。共纳入41项研究，涉及88228例患者（58366例接受手术治疗，29862例接受SBRT治疗）。与SBRT相比，手术切除与三年OS改善显著相关（HR = 1.39；95% CI：1.25 - 1.55；p < 0.00001）。亚组分析显示，肺叶切除术（HR = 1.50；p < 0.00001）比肺叶下切除术（HR = 1.27；p = 0.002）或混合术式（HR = 1.39；p = 0.007）具有更大的生存获益。CSS也有利于手术（HR = 1.22；p = 0.006），尤其是肺叶切除术（HR = 1.46；p = 0.002）。SBRT与手术的LC相当（HR = 0.92；p = 0.06），尽管肺叶切除术显示出轻微优势（HR = 0.92；p = 0.04）。这些发现表明，在早期NSCLC中，与SBRT相比，手术切除尤其是肺叶切除术具有更好的OS和CSS，而LC结果通常相当。SBRT仍然是医学上无法手术患者的有效替代方案；然而，对于可手术的患者，应考虑将手术作为首选方法以最大化长期疗效。
