Efficacy of induction chemotherapy or chemoradiotherapy followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small cell lung cancer: A systematic review and meta-analysis
- VernacularTitle:诱导化疗或放化疗后手术切除和同步放化疗治疗ⅢA-N2 期非小细胞肺癌疗效的系统评价与 Meta 分析
- Author:
Hua HE
1
;
Wenteng HU
2
;
Minjie MA
2
;
Biao HAN
2
Author Information
1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, P. R. China
2. The First Hospital of Lanzhou University, Lanzhou, 730030, P. R. China
- Publication Type:Journal Article
- Keywords:
Radiotherapy;
surgical treatment;
stage ⅢA-N2 non-small cell lung cancer;
systematic review/meta-analysis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2023;30(01):133-139
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically evaluate the efficacy of neoadjuvant chemoradiotherapy or chemotherapy followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small cell lung cancer (NSCLC). Methods We searched PubMed, EMbase, Web of Science and The Cochrane Library to collect clinical studies on the efficacy comparison between neoadjuvant chemoradiotherapy or chemotherapy followed by surgery and definitive chemoradiation in stage ⅢA-N2 NSCLC from inception to September 2022. The meta-analysis was performed by using RevMan 5.3 software. Results A total of 9 studies (3 randomized controlled trials and 6 retrospective cohort studies) with 12 801 patients were included. The results of meta-analysis showed that there was no statistical difference in the progression-free survival rate between the inductive treatment followed by surgery (including lobectomy and pneumonectomy) and definitive chemoradiation (HR=0.99, 95%CI 0.86-1.15, P=0.91). Compared with definitive chemoradiation, the overall survival (OS) rate in the inductive treatment followed by surgery (including lobectomy and pneumonectomy) was lower (HR=1.24, 95%CI 1.09-1.42, P=0.001), while the OS rate in the inductive treatment followed by lobectomy was higher (HR=0.55, 95%CI 0.51-0.61, P<0.000 01). And the local recurrence rate in the inductive treatment followed by surgery was reduced (OR=0.44, 95%CI 0.36-0.55, P<0.000 01). Conclusion Neoadjuvant chemoradiotherapy or chemotherapy followed by lobectomy is superior to definitive chemoradiation in OS and it has a lower local recurrence rate, so lobectomy should be one of the multidisciplinary treatments for selected ⅢA-N2 NSCLC patients.
