立体定向放疗与手术治疗早期NSCLC临床疗效meta分析  

Efficacy of Stereotactic Body Radiotherapy versus Surgery for the Treatment of Early Non-small Cell Lung Cancer:A Meta-analysis

作　　者：武强彬[1] 高万朋[1] 朱家旺[1] 王强[2] 张伟[3] Qiangbin WU;Wanpeng GAO;Jiawang ZHU;Qiang WANG;Wei ZHANG(Department of Emergency Medicine,Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300150,China;Department of Respiration Medicine,Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300150,China;Department of Thoracic Surgery,Tianjin People's Hospital,Tianjin 300121,China)

机构地区：[1]天津中医药大学第二附属医院急诊内科,天津300150 [2]天津中医药大学第二附属医院呼吸科,天津300150 [3]天津市人民医院胸外科,天津300121

出　　处：《中国肺癌杂志》2020年第12期1066-1072,共7页Chinese Journal of Lung Cancer

摘　　要：背景与目的采用循证医学方法探讨立体定向放疗(stereotactic body radiotherapy,SBRT)与手术治疗早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效有无差异。方法检索PubMed、EMBASE、中国知网、万方等数据库中2020年6月以前发表的相关文献,由两名研究人员独立进行检索及提取数据,采用Stata 13.0软件对纳入文献中两种治疗方法的总生存率和癌症特异性生存率进行meta分析,根据倾向性评分匹配后研究和手术类型(肺叶切除术、肺段切除术及胸腔镜辅助手术)进行亚组分析。结果最终纳入文献14篇,其中SBRT组15,841例,手术组17,708例,9篇采用了倾向性评分匹配方法。13篇为回顾性队列研究,1篇为随机临床对照试验。Meta分析结果显示手术组和SBRT组的总生存率差异有统计学意义,SBRT组的总生存率(HR=1.51,95%CI:1.31-1.74)劣于手术组。在手术类型的亚组分析中,SBRT组与各手术类型均无统计学差异。采用了倾向性评分匹配后,SBRT组与手术组的总生存率差异仍有统计学意义(HR=1.66,95%CI:1.45-1.90)。手术组和SBRT组的癌症特异性生存率无统计学差异(HR=1.12,95%CI:0.83-1.52)。结论手术治疗的总生存率优于SBRT治疗,但在癌症特异性生存率上无明显优势。Background and objective To compare the clinical efficacy of stereotactic body radiotherapy(SBRT)versus surgery for early-stage non-small cell lung cancer through evidence based medicine analysis.Methods A systematic search was performed in the PubMed,EMBASE,CNKI and Wan Fang databases to find studies published before June 2020.Two authors independently extracted the data and assessed the eligibility.All of the statistical analyses were performed using Stata 13.0.Subgroup analysis were performed according to the score matching study and operation type(lobectomy,segmentectomy and thoracoscopic assisted surgery).Results Finally,14 articles were included,including 15,841 cases in SBRT group and 17,708 cases in operation group.10 articles used propensity score matching methods for survival analysis.Thirteen were retrospective cohort studies and one was randomized controlled trial.The results of meta-analysis showed that the overall survival rate of the surgery group and the SBRT group was statistically significant.The overall survival rate of the SBRT group(HR=1.51,95%CI:1.31-1.74)was inferior to that of the surgery group.In the subgroup analysis of the surgical type,there was no statistical difference between the SBRT group and each surgical type.The difference of overall survival rate between SBRT group and surgery group was statistically significant(HR=1.66,95%CI:1.45-1.90)in studies of propensity score matching.There was no statistically significant difference in cancer-specific survival between the surgery and SBRT groups(HR=1.12,95%CI:0.83-1.52).Conclusion The overall survival rate of surgical treatment is better than that of SBRT,but it has no obvious advantages in cancer specific survival rate.

关 键 词：立体定向放疗 手术 肺肿瘤 META分析 

分 类 号：R734.2[医药卫生—肿瘤]