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. 2019 Jun 24;10(17):3941-3949.
doi: 10.7150/jca.28680. eCollection 2019.

The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis

Tingting Liu  1 , Yanshu Mu  2 , Jun Dang  1 , Guang Li  1
Affiliations

The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis

Tingting Liu et al. J Cancer. .

Abstract

Background: The role of postoperative radiotherapy (PORT) in completely resected pathological stage IIIA-N2 (pIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. This meta-analysis aimed to assess the effect of PORT in patients with pIIIA-N2 NSCLC on the basis of clinicopathological features. Methods: The PubMed, PubMed Central (PMC), Embase, Web of Science, and Cochrane Library were searched for relevant studies. The main outcomes were overall survival (OS) and disease-free survival (DFS), which were compared using the hazard ratio (HR). Results: One randomized trial and 12 retrospective studies were eligible for the analysis. PORT significantly improved both OS [HR = 0.85; 95% confidence interval (CI): 0.79-0.92] and DFS (HR = 0.57; 95% CI: 0.38-0.85) compared with non-PORT treatment in patients with multiple N2 metastases or multiple N2 station involvement. No significant difference in either OS (HR = 1.03; 95% CI: 0.86-1.24) or DFS (HR = 1.08; 95% CI: 0.70-1.65) was found between PORT and non-PORT groups for patients with single N2 station involvement. No significant heterogeneity was observed. No significant differences in OS were observed between PORT and non-PORT groups for patients of different ages, sex, tumor sizes or pT stages, and histological types. Conclusions: The findings of this meta-analysis supported a role for PORT in patients with completely resected pIIIA-N2 NSCLC having multiple N2 metastases and favored withholding PORT to patients with single N2 station involvement. Further prospective randomized controlled trials are needed to confirm the findings.

Keywords: Clinicopathological features; Meta-analysis.; Non-small cell lung cancer; Postoperative radiotherapy; Stage IIIA-N2.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Literature search and selection.
Figure 2
Figure 2
Forest plots of HRs for OS and DFS in patients with multiple N2 metastases or multiple N2 station involvement. (A) OS; (B) DFS. CI, Confidence interval; DFS, disease-free survival; IV, inverse variance method; OS, overall survival; PORT, postoperative radiotherapy; SE, standard error.
Figure 3
Figure 3
Forest plots of HRs for OS and DFS in patients with single N2 station involvement. (A) OS; (B) DFS. PORT: postoperative radiotherapy; CI, Confidence interval; DFS, disease-free survival; IV, inverse variance method; OS, overall survival; PORT, postoperative radiotherapy; SE, standard error.
Figure 4
Figure 4
Sensitivity analysis for comparing OS between the PORT and non-PORT groups. (A) In studies investigating multiple N2 metastases or multiple N2 station involvement; (B) in studies investigating single N2 station involvement. PORT, Postoperative radiotherapy.
Figure 5
Figure 5
Forest plots of HRs for OS in patients with other clinicopathological features. (A) Tumor size >3 cm or T2-3 tumors; (B) tumor size ≦3 cm or T1 tumors; (C) age ≥60 years; (D) age <60 years.
Figure 6
Figure 6
Forest plots of HRs for OS in patients with other clinicopathological features. (A) Squamous cell carcinoma; (B) adenocarcinoma; (C) male; (D) female.
See this image and copyright information in PMC

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