Surgery for non-small cell lung cancer: systematic review and meta-analysis of randomised controlled trials
Surgery for non-small cell lung cancer: systematic review and meta-analysis of randomised controlled trials
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DOI：
10.1136/thx.2005.051995
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发表时间：
2006-07-01
期刊：
影响因子：
10
通讯作者：
Campbell, D. A.
中科院分区：
文献类型：
--
作者：
Wright, G.;Manser, R. L.;Campbell, D. A.
背景资料：手术被认为是可切除的I期和II期患者的治疗选择（以及一些IIIA期）非小细胞肺癌（NSCLC）患者，但之前尚未发表系统评价。方法：对随机对照试验进行了系统回顾和荟萃分析，以确定与非手术切除相比，手术切除是否能改善I-IIIA期NSCLC患者的疾病特异性死亡率。结果：共纳入11项临床试验。没有研究有未治疗的对照组。在对3项试验的汇总分析中，与淋巴结采样相比，接受切除术的I-IIIA期NSCLC患者（接受完整纵隔淋巴结清扫）的4年生存率上级（风险比估计为0.78（95% CI 0.65 - 0.93））。另一项试验报告，与肺叶切除术相比，I期NSCLC患者接受有限切除术治疗的局部复发率增加。一项小型研究报告，与化疗后放疗相比，化疗后手术治疗的IIIA期NSCLC患者具有生存优势。没有其他试验报道显着改善手术后的生存率与非手术treatment.Conclusion：这是很难得出结论的局部非小细胞肺癌手术的疗效，因为参与者的研究和方法的试验的弱点数量少。然而，目前的证据表明，在接受切除术的I-IIIA期NSCLC患者中，与淋巴结取样相比，完全纵隔淋巴结清扫术与生存率改善相关。
Background: Surgery is considered the treatment of choice for patients with resectable stage I and II (and some patients with stage IIIA) non-small cell lung cancer (NSCLC), but there have been no previously published systematic reviews.Methods: A systematic review and meta-analysis of randomised controlled trials was conducted to determine whether surgical resection improves disease specific mortality in patients with stages I-IIIA NSCLC compared with non-surgical treatment, and to compare the efficacy of different surgical approaches.Results: Eleven trials were included. No studies had untreated control groups. In a pooled analysis of three trials, 4 year survival was superior in patients undergoing resection with stage I-IIIA NSCLC who had complete mediastinal lymph node dissection compared with lymph node sampling (hazard ratio estimated at 0.78 (95% CI 0.65 to 0.93)). Another trial reported an increased rate of local recurrence in patients with stage I NSCLC treated with limited resection compared with lobectomy. One small study reported a survival advantage among patients with stage IIIA NSCLC treated with chemotherapy followed by surgery compared with chemotherapy followed by radiotherapy. No other trials reported significant improvements in survival after surgery compared with non-surgical treatment.Conclusion: It is difficult to draw conclusions about the efficacy of surgery for locoregional NSCLC because of the small number of participants studied and methodological weaknesses of the trials. However, current evidence suggests that complete mediastinal lymph node dissection is associated with improved survival compared with node sampling in patients with stage I-IIIA NSCLC undergoing resection.