Stereotactic Ablative Radiotherapy Versus Surgery in Early Lung Cancer: A Meta-Analysis of Propensity Score Studies
A partir d'une revue de la littérature publiée jusqu'en décembre 2016 (16 études), cette étude analyse l'intérêt, du point de vue de la survie, d'une radiothérapie ablative stéréotaxique par rapport à un traitement chirurgical chez les patients atteints d'un cancer du poumon non à petites cellules de stade précoce
Background : As no completed randomized trials of surgery versus stereotactic ablative radiotherapy (SABR) in patients with early-stage non-small cell lung cancer are available, numerous propensity score studies have attempted to mimic the setting of clinical trials using non-randomized data. We performed a meta-analysis of propensity score studies comparing SABR and surgery. Methods : The Medline and Embase databases were queried up to December 2016. Two authors independently reviewed the records for inclusion and extracted outcome measures. The study was conducted according to PRISMA and MOOSE guidelines. Primary meta-analysis and secondary analyses were carried out using R (v3.3.2) at a significance level of 0.05. Results : Sixteen studies were included in the meta-analysis. Overall survival favored surgery (SABR versus surgery hazard ratio = 1.48 [95% confidence interval: 1.26-1.72], I2 = 80.5%). Lung cancer-specific survival was not significantly different between SABR and surgery (hazard ratio = 1.17 [0.92-1.50], I2 = 18.6%). On stratification, overall survival favored both lobectomy and sublobar resection over SABR, though lung cancer-specific survival was again not significantly different. On secondary analysis, lymph node upstaging rate was 15.6% following surgery, with 11.4% of patients receiving chemotherapy. Propensity score-matching caliper distance and first author specialty was found to be associated with survival endpoints on regression. Conclusions : For patients with early stage non-small cell lung cancer who are eligible for either treatment, better overall survivals were seen after surgery compared to SABR. However, lung cancer-specific survival was similar for both treatments. Prospective clinical trials are preferred to propensity analyses in evaluating the nature of non-cancer related mortality post-SABR.
http://www.redjournal.org/article/S0360-3016(18)30178-0/fulltext 2018