电视辅助胸腔镜手术和体部立体定向放疗治疗早期非小细胞肺癌的临床疗效比较

BACKGROUND AND OBJECTIVE: More and more chest physicians chose video-assisted thoracoscopic surgery (VATS) to treat early stage non-small cell lung cancer (NSCLC). In recent years, there is still lack of a random trial comparing the clinical outcomes of VATS and stereotactic body radiotherapy (SBRT) in treating NSCLC. To provide a reference for the choice between VATS and SBRT, in the current meta-analysis, we compared the clinical outcomes of these two therapies in treating NSCLC. METHODS: Five major medical databases, CNKI, CPVIP (http://www.cqvip.com/), PubMed, Embase, and ISI web of science were systematically searched to identify all studies from January 2010 to February 2016 on VATS and SBRT therapies. Finally, original English or Chinese publications of stage Ⅰ and Ⅱ NSCLC with adequate patients and adequate SBRT doses were enrolled. A multivariate random effects model was used to perform a meta-analysis to compare overall survival and disease free survival between VATS and SBRT while adjusting for median age and operable patient numbers. RESULTS: Fourteen VATS studies (included 3, 482 patients) and nineteen SBRT studies (included 3, 997 patients) published in the same period were eligible. The median age and follow-up duration were 64 years and 43.4 months for VATS patients and 74 years and 29.5 months for SBRT patients, respectively. The mean unadjusted overall survival rates at 1, 2, 3, and 5 years with VATS were 93.5%, 84.9%, 77.0% and 76.3% compared to 89.0% 73.3% 59.0% and 36.7% with SBRT. The mean unadjusted disease free survival rates at 1, 2, 3, and 5 years with VATS were 93.6%, 88.6%, 85.6% and 75.6% compared to 79.3%, 72.1%, 64.9% and 58.9% with SBRT. While, after adjusted for proportion of operable patients and median age, the estimate overall survival rates at 1, 2, 3, and 5 years with VATS were 94%, 92%, 84% and 71% compared to 98%, 95%, 87% and 83% with SBRT. And the estimate disease free survival rates at 1, 2, 3, and 5 years with VATS were 97%, 94%, 85% and 75% compared to 88%, 81%, 74% and 63% with SBRT. CONCLUSION: Before adjustment, the SBRT group showed worse clinical outcomes (overall survival and disease free survival) than VATS group. When take consider of median age and operability, the patients with SBRT differ substantially from patients treated with VATS. After adjustment of median age and operability, there are no significant differences between these two therapy in treating NSCLC.