Yi Zhao1, Wei Wang1, Hengrui Liang1, Chi-Fu Jeffrey Yang2, Thomas D'Amico2, Calvin S H Ng3, Chia-Chuan Liu4, René Horsleben Petersen5, Gaetano Rocco6, Alessandro Brunelli7, Jun Liu1, Jiaxi He1, Weizhe Huang1, Wenhua Liang8, Jianxing He1. 1. Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China. 2. Section of General Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. 3. Department of Surgery, Prince of Wales Hospital, Hong Kong, China. 4. Division of Thoracic Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan. 5. Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. 6. Division of Thoracic Surgical Oncology, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy. 7. Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom. 8. Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Respiratory Disease, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; National Clinical Research Center for Respiratory Disease, Guangzhou, China. Electronic address: liangwh1987@163.com.
Abstract
BACKGROUND: The optimal treatment for stage IIIA-N2 non-small cell lung cancer (NSCLC) is controversial. We aimed to address this important issue through a Bayesian network meta-analysis. METHODS: We performed a search of electronic databases for randomized controlled trials comparing the following treatments: surgery, radiotherapy, chemotherapy, and their multiple combinations before March 25, 2018. Pooled data on overall survival and treatment-related deaths were analyzed within the Bayesian framework. RESULTS: Eighteen eligible trials reporting 13 treatments were included. In terms of overall survival, neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy, which tended to be consistent (hazard ratio [HR] 1.14, 95% credible interval [CrI] 0.21 to 5.93), ranked superior to other treatments. Notably, neoadjuvant chemotherapy followed by surgery and adjuvant radiotherapy was significantly more effective in prolonging survival than surgery alone (HR 0.38, 95% CrI 0.18 to 0.81), surgery plus adjuvant radiotherapy (HR 0.51, 95% CrI 0.29 to 0.92) and potentially surgery plus adjuvant chemotherapy (HR 0.49, 95% CrI 0.23 to 1.05). Overall, with 29% as the highest possibility of causing the fewest treatment-related deaths, neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy was the safest treatment option. CONCLUSIONS: Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy has the greatest possibility to be the optimal treatment with the best overall survival and fewest treatment-related deaths for stage IIIA-N2 NSCLC.
BACKGROUND: The optimal treatment for stage IIIA-N2 non-small cell lung cancer (NSCLC) is controversial. We aimed to address this important issue through a Bayesian network meta-analysis. METHODS: We performed a search of electronic databases for randomized controlled trials comparing the following treatments: surgery, radiotherapy, chemotherapy, and their multiple combinations before March 25, 2018. Pooled data on overall survival and treatment-related deaths were analyzed within the Bayesian framework. RESULTS: Eighteen eligible trials reporting 13 treatments were included. In terms of overall survival, neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy, which tended to be consistent (hazard ratio [HR] 1.14, 95% credible interval [CrI] 0.21 to 5.93), ranked superior to other treatments. Notably, neoadjuvant chemotherapy followed by surgery and adjuvant radiotherapy was significantly more effective in prolonging survival than surgery alone (HR 0.38, 95% CrI 0.18 to 0.81), surgery plus adjuvant radiotherapy (HR 0.51, 95% CrI 0.29 to 0.92) and potentially surgery plus adjuvant chemotherapy (HR 0.49, 95% CrI 0.23 to 1.05). Overall, with 29% as the highest possibility of causing the fewest treatment-related deaths, neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy was the safest treatment option. CONCLUSIONS: Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy has the greatest possibility to be the optimal treatment with the best overall survival and fewest treatment-related deaths for stage IIIA-N2 NSCLC.
Authors: Hari B Keshava; Kay See Tan; Joseph Dycoco; Jennifer Livschitz; Matthew J Bott; James Huang; Valerie W Rusch; James M Isbell; Daniela Molena; Manjit S Bains; David R Jones; Gaetano Rocco Journal: Semin Thorac Cardiovasc Surg Date: 2020-08-25