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Comparative Study
. 2025 Aug 1;111(8):5535-5548.
doi: 10.1097/JS9.0000000000002594. Epub 2025 May 28.

Comparative effectiveness for early-stage NSCLC without lymph node involvement based on prospective studies

Xue Yang  1 , Zherui Xing  1 , Sirui Long  1 , Xiaoxi Yu  1 , Nanhao Yin  1 , Kailin Deng  2 , Deying Kang  3 , Feng-Ming Spring  4 , You Lu  1   5 , Ren Luo  1   5 , Jianxin Xue  1   5
Affiliations
Comparative Study

Comparative effectiveness for early-stage NSCLC without lymph node involvement based on prospective studies

Xue Yang et al. Int J Surg. .

Abstract

Background: There is ongoing uncertainty in comparing surgical and nonsurgical therapies, with or without systemic options, in heterogeneous early-stage non-small cell lung cancer without lymph node involvement (eNSCLC-N0).

Materials and methods: We conducted an integrated evidence synthesis of prospective randomized controlled trials (RCTs) and non-RCTs, covering four databases through September 1, 2024. Treatment effects were evaluated using single-arm, pair-wise, and Bayesian random-effects network meta-analyses. Primary outcomes were overall survival and disease-free survival (DFS); secondary outcomes included recurrence and grade ≥3 adverse events.

Results: This report included 31 clinical trials (24 RCTs) with 12 049 patients. In the network analyses, adjuvant targeted therapy (ATKI) (rank 1) significantly improved DFS compared with mixed radical resection (hazard ratio [HR], 0.21; 95% confidence interval [CI], 0.05-0.90; rank 14; GRADE, very low) in the overall population. For patients with wild-type/unknown EGFR status, stereotactic body radiation therapy (SBRT) plus immune checkpoint inhibitors (rank 1) showed DFS benefit over SBRT alone (HR, 0.17; 95% CI, 0.03-0.83; rank 3; GRADE, high) and was non-inferior to adjuvant platinum-based chemotherapy (HR, 0.18; 95% CI, 0.02-1.65; rank 2; GRADE, very low).

Conclusion: These findings suggest the combination of systemic therapies, such as surgery plus ATKI or SBRT plus immunotherapy, superior approaches for patients with eNSCLC-N0 depending on the genomic mutation status and patient tolerability.

Keywords: early-stage NSCLC; immunotherapy; network meta-analysis; personalized medicine; stereotactic body radiation therapy; targeted therapy.

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References

    1. Leiter A, Veluswamy RR, Wisnivesky JP. The global burden of lung cancer: current status and future trends. Nat Rev Clin Oncol 2023;20:624–39.
    1. Singareddy A, Flanagan ME, Samson PP, et al. Trends in stage I lung cancer. Clin Lung Cancer 2023;24:114–19.
    1. Tie H, Luo J, Shi R, et al. Characteristics and prognosis of synchronous multiple primary lung cancer after surgical treatment: a systematic review and meta-analysis of current evidence. Cancer Med 2021;10:507–20.
    1. Chang JY, Liu YH, Zhu Z, et al. Stereotactic ablative radiotherapy: a potentially curable approach to early stage multiple primary lung cancer. Cancer 2013;119:3402–10.
    1. Chang JY, Li QQ, Xu QY, et al. Stereotactic ablative radiation therapy for centrally located early stage or isolated parenchymal recurrences of non-small cell lung cancer: how to fly in a “no fly zone. Int J Radiat Oncol Biol Phys 2014;88:1120–28.

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