The Optimal Treatment for Stage IIIA-N2 Non-small-cell Lung Cancer: A Network Meta-analysis

Abstract Background The optimal treatment for stage IIIA-N2 non-small-cell lung cancer (NSCLC) is controversial. We aimed to address this important issue through a Bayesian network meta-analysis. Methods We performed a search of electronic databases for randomized controlled trials comparing the following treatments: surgery, radiotherapy, chemotherapy and their multiple combinations before March 25, 2018. Pooled data on overall survival and treatment-related deaths were analyzed within the Bayesian framework. Results Eighteen eligible trials reporting 13 treatments were included. In terms of overall survival, neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy, which tended to be consistent (hazard ratio 1.14, 95% credible interval 0.21-5.93), ranked superior to other treatments. Notably, neoadjuvant chemotherapy followed by surgery and adjuvant radiotherapy was significantly more effective in prolonging survival than surgery alone (0.38, 0.18-0.81), surgery plus adjuvant radiotherapy (0.51, 0.29-0.92) and potentially surgery plus adjuvant chemotherapy (0.49, 0.23-1.05). Overall, with 29% as the highest possibility of causing the fewest treatment-related deaths, neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy was the safest treatment option. Conclusions Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy or radiotherapy has the greatest possibility to be the optimal treatment with the best overall survival and fewest treatment-related deaths for stage IIIA-N2 NSCLC.