Meta-analysis of the effect of preoperative neoadjuvant therapy and radical chemoradiotherapy on ⅢA (N2) NSCLC
JING Xiaoliang1 ZHANG Liwei1 ZONG Liang1 LI Desheng1 Julaiti·Ainiwaer1 YANG Fan2
1.Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Autonomous Region, Urumqi 830054, China;
2.Department of Thoracic Surgery, Xinhe People′s Hospital, Xinjiang Autonomous Region, Aksu 842100, China
Abstract：Objective To compare the effects of preoperative neoadjuvant therapy combined surgery with radical chemoradiotherapy for stage ⅢA (N2) non-small cell lung cancer (NSCLC). Methods PubMed, Medline, Ovid, CNKI, VIP and Wanfang databases were retrieved by computer, and supplemented by manual search. The publicly published studies concerning the treatment of stage Ⅲ A (N2) NSCLC with neoadjuvant therapy combined surgery and radical chemotherapy were collected from building database to April 2018, and the samples were divided into neoadjuvant therapy combined surgery group and radical chemoradiotherapy group according to the treatment method. Results A total of 14 studies met the inclusion criteria, including 5 randomized controlled trials, 9 retrospective case-control studies, with a total sample size of 12 713 cases, including 1792 cases in neoadjuvant therapy combined surgery group and 10 921 cases in radical chemoradiotherapy group. The 3-year survival rate of the neoadjuvant therapy combination surgery group in the randomized controlled trial was not significantly different from the radical chemotherapy group (OR = 0.93, 95% CI: 0.71-1.22, P = 0.61). In the case-control study, the 3-year survival rate of the neoadjuvant combination surgery group was superior to that of the radical chemotherapy group (OR = 0.63, 95% CI: 0.55 - 0.72, P < 0.00 001). The 5-year survival rate of the neoadjuvant therapy combined surgery group in the randomized controlled trial was not significantly different from the radical chemoradiotherapy group (OR = 0.77, 95% CI: 0.52-1.12, P = 0.17). In the case-control study, the 5-year survival rate of the neoadjuvant combined surgery group was better than that of the radical chemo group (OR = 0.36, 95% CI: 0.25-0.51, P < 0.00 001). Conclusion Neoadjuvant therapy combined with surgical treatment can make patients with stage Ⅲ A (N2) NSCLC have longer survival time or achieve cure effect. Pneumonectomy after neoadjuvant therapy may be safe and feasible. Further randomized controlled studies on survival analysis of patients undergoing neoadjuvant therapy combined with surgery, especially pneumonectomy, are of great significance.
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2019, Vol. 16 
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