The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis
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The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer : A Network Meta-Analysis. / Zhao, Yi; Wang, Wei; Liang, Hengrui; Yang, Chi-Fu Jeffrey; D'Amico, Thomas; Ng, Calvin S H; Liu, Chia-Chuan; Petersen, René Horsleben; Rocco, Gaetano; Brunelli, Alessandro; Liu, Jun; He, Jiaxi; Huang, Weizhe; Liang, Wenhua; He, Jianxing; AME Thoracic Surgery Collaborative Group.
In: The Annals of Thoracic Surgery, Vol. 107, No. 6, 2019, p. 1866-1875.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer
T2 - A Network Meta-Analysis
AU - Zhao, Yi
AU - Wang, Wei
AU - Liang, Hengrui
AU - Yang, Chi-Fu Jeffrey
AU - D'Amico, Thomas
AU - Ng, Calvin S H
AU - Liu, Chia-Chuan
AU - Petersen, René Horsleben
AU - Rocco, Gaetano
AU - Brunelli, Alessandro
AU - Liu, Jun
AU - He, Jiaxi
AU - Huang, Weizhe
AU - Liang, Wenhua
AU - He, Jianxing
AU - AME Thoracic Surgery Collaborative Group
N1 - Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
U2 - 10.1016/j.athoracsur.2018.11.024
DO - 10.1016/j.athoracsur.2018.11.024
M3 - Review
C2 - 30557543
VL - 107
SP - 1866
EP - 1875
JO - The Annals of Thoracic Surgery
JF - The Annals of Thoracic Surgery
SN - 0003-4975
IS - 6
ER -
ID: 225120098