Survival after SBRT for Clinically diagnosed or Biopsy-proven Early-stage Non-small Cell Lung Cancer: A Systematic Review and Meta-Analysis
A partir d'une revue systématique de la littérature (43 articles), cette méta-analyse évalue, en fonction de la modalité utilisée pour établir le diagnostic (indicateurs cliniques ou résultats de la biopsie), les taux de survie à 3 et 5 ans des patients atteints d'un cancer du poumon non à petites cellules de stade précoce traité par radiothérapie corporelle stéréotaxique
Introduction : SBRT is a promising curative treatment for early-stage NSCLC. IT is unclear if survival outcomes for SBRT are influenced by a lack of pathological confirmation of malignancy and staging of disease in these patients. In this systematic review and meta-analysis we assess survival outcomes after SBRT in studies with patients with clinically diagnosed vs biopsy-proven early-stage NSCLC. Methods : The main databases were searched for trials and cohort studies without restrictions to publication status or language. Two independent researchers performed the screening and selection of eligible studies. Outcomes were overall survival, cancer-specific survival and disease-free survival. The inverse variance method and the random effects method for meta-analysis were utilized to assess pooled survival estimates. Results : A total of 11195 non-duplicate records were identified by the original search strategy. After screening by title and abstract, 1051 potentially eligible records were identified. A total of 43 articles were included. The comparative studies showed lower 3-y overall survival and lower 2-y and 5-y cancer specific survival for biopsy-proven disease compared to clinical disease. However, 5-y OS was the same for both groups. For the pooled estimates, 3-y disease-free survival and 2-y cancer-specific survival were lower for biopsied disease. Conclusions : Results of this systematic review and meta-analysis show a discrepancy in oncological outcomes for patients undergoing SBRT for suspected early-stage NSCLC in whom there is pathological conformation of malignancy and those who there is only a clinical diagnose of NSCLC. These results emphasize the importance of obtaining pathological proof of malignancy.