Sublobar resection is associated with improved outcomes over radiotherapy in the management of high-risk elderly patients with Stage I non-small cell lung cancer: a systematic review and meta-analysis

// Huan-Huan Wang 1, * , Chun-Ze Zhang 2, * , Bai-Lin Zhang 1 , Jie Chen 1 , Xian-Liang Zeng 1 , Lei Deng 3 , Mao-Bin Meng 1 1 Department of Radiation Oncology, Tianjin’s Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China 2 Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, China 3 Department of Thoracic Cancer and Huaxi Student Society of Oncology Research, West China Hospital, West China School of Medicine, Sichuan University, Sichuan Province 610041, China * These authors contributed equally to this work Correspondence to: Mao-Bin Meng, email: mmeng@tmu.edu.cn Keywords: non-small cell lung cancer, radiotherapy, sublobar resection, overall survival, pattern of failure Received: October 04, 2016      Accepted: December 12, 2016      Published: December 17, 2016 ABSTRACT Background and Aim: A matched-pair comparison was performed to compare the efficacy and safety of sublobar resection versus radiotherapy for high-risk elderly patients with Stage I non-small cell lung cancer (NSCLC). Patients and Methods: We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE and manual searches. The meta-analysis was performed to compare overall survival, pattern of failure, and toxicity among the homogeneous studies. Subdivided analyses were also performed. Results: Sixteen studies containing 11540 patients were included in the meta-analysis. Among these studies, 9 were propensity-score matched (PSM) cohort studies, and 7 were cohort studies. Sublobar resection, compared with radiotherapy (either conventional fraction radiation therapy or stereotactic body radiation therapy), significantly improved the overall survival regardless in both PSM and non-PSM analyses (all p 0.05). Conclusions: Sublobar resection was associated with improved outcomes in high-risk elderly patients with Stage I NSCLC, which supports the need to compare both treatments in large prospective, randomized, controlled clinical trials.