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Neoadjuvant chemoradiotherapy or chemotherapy followed by surgery is superior to that followed by definitive chemoradiation or radiotherapy in stage IIIA (N2) nonsmall-cell lung cancer: a meta-analysis and system review

Authors Xu X, Dan L, Chen W, Zhu S, Mao W

Received 1 September 2015

Accepted for publication 22 January 2016

Published 22 February 2016 Volume 2016:9 Pages 845—853


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Manfred Beleut

Peer reviewer comments 2

Editor who approved publication: Dr Saad Khan

Xiao-Ling Xu,1,* Li Dan,1,* Wei Chen,1 Shuang-Mei Zhu,2 Wei-Min Mao1

1Key Laboratory of Diagnosis and Treatment Technology for Thoracic Cancer, Zhejiang Cancer Research Institute, Zhejiang Province Cancer Hospital, Zhejiang Cancer Center, Hangzhou, 2Department of Radiotherapy, Lishui People’s Hospital, Lishui, People’s Republic of China

*These authors contributed equally to this work

Background: Approximately 30% of all cases of nonsmall-cell lung cancer (NSCLC) are of a locally advanced (IIIA or IIIB) stage. However, surgical therapy for patients with stage IIIA (N2) NSCLC is associated with a disappointing 5-year survival rate. The optimal treatment for stage IIIA (N2) NSCLC is still in dispute.
Methods: A literature search was performed in the PubMed, Embase, and MEDLINE databases (last search updated in March 2015), and a meta-analysis of the available data was conducted. Two authors independently extracted data from each eligible study.
Results: A total of nine studies, including five randomized controlled trials and four retrospective studies, were enrolled in this meta-analysis. Significant homogeneity (χ2=49.62, P=0.000, I2=81.9%) was detected between four of the studies, including a total of 11,948 selected cases. Among the nine studies that investigated overall survival, the pooled hazard ratio (HR) was 0.70 (95% confidence interval (CI): 0.56–0.87; P=0.000). Subgroup analyses were performed according to the study design and the extent of resection. We observed a statistically significant better outcome after lobectomy (pooled HR: 0.52; 95% CI: 0.47–0.58; P=0.000) than after pneumonectomy (pooled HR: 0.82; 95% CI: 0.69–0.98; P=0.028). Unfortunately, there was no significant difference between the randomized controlled studies, as the pooled HR was 0.94 (95% CI: 0.81–1.09; P=0.440).
Conclusion: Neoadjuvant chemoradiotherapy or chemotherapy followed by surgery (particularly lobectomy) is superior to following these therapies with definitive chemoradiation or radiotherapy, particularly in patients undergoing lobectomy.

nonsmall cell lung carcinoma, N2 stage, therapy, surgery, chemoradiotherapy, lobectomy

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