Meta-analysis identifies optimal treatment for stage IIIa-N2 NSCLC

  • Zhao Y & al.
  • Ann Thorac Surg
  • 14 déc. 2018

  • Par Kelli Whitlock Burton
  • Résumés d'articles
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Takeaway

  • Neoadjuvant chemotherapy (NACT)+surgery and adjuvant radiotherapy (CSR sequence) and NACT+surgery and adjuvant chemotherapy (CSC sequence) offer the best OS for stage IIIA-N2 NSCLC, according to a meta-analysis.

Why this matters

  • Studies on the optimal treatment for N2 disease have yielded conflicting results.

Study design

  • Meta-analysis of 18 randomized controlled trials with 2158 patients with stage IIIA-N2 NSCLC.
  • Funding: None disclosed.

Key results

  • Best treatments:
    • CSC and CSR had the lowest mortality risk (both 29%).
    • CSC and CSR offered the best OS (HR, 1.14, 95% credible interval [CrI], 0.21-5.93).
    • CSR had significant survival benefit over:
      • Surgery alone: HR, 0.38; 95% CrI, 0.18-0.81.
      • Surgery followed by adjuvant radiotherapy: HR, 0.51; 95% CrI, 0.29-0.92.
    • Significantly longer OS than surgery alone was also noted for:
      • Surgery followed by adjuvant chemotherapy: HR, 0.77; 95% CrI, 0.60-0.99.
      • NACT followed by surgery: HR, 0.61; 95% CrI, 0.37-0.99.
      • Sequential chemoradiotherapy: HR, 0.57; 95% CrI, 0.33-0.99.
      • Surgery followed by adjuvant concurrent chemoradiotherapy: HR, 0.67; 95% CrI, 0.46-0.99.

Limitations

  • Most treatments compared indirectly.
  • No studies on targeted molecular therapy, immunotherapy, and other systemic treatments.