The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis

Yi Zhao; Wei Wang; Hengrui Liang; Chi-Fu Jeffrey Yang; Thomas D'Amico; Calvin S H Ng; Chia-Chuan Liu; René Horsleben Petersen; Gaetano Rocco; Alessandro Brunelli; Jun Liu; Jiaxi He; Weizhe Huang; Wenhua Liang; Jianxing He; AME Thoracic Surgery Collaborative Group

doi:10.1016/j.athoracsur.2018.11.024

The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis

Yi Zhao, Wei Wang, Hengrui Liang, Chi-Fu Jeffrey Yang, Thomas D'Amico, Calvin S H Ng, Chia-Chuan Liu, René Horsleben Petersen, Gaetano Rocco, Alessandro Brunelli, Jun Liu, Jiaxi He, Weizhe Huang, Wenhua Liang, Jianxing He, AME Thoracic Surgery Collaborative Group

Department of Clinical Medicine

20 Citations (Scopus)

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 [HR] 1.14, 95% credible interval [CrI] 0.21 to 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 (HR 0.38, 95% CrI 0.18 to 0.81), surgery plus adjuvant radiotherapy (HR 0.51, 95% CrI 0.29 to 0.92) and potentially surgery plus adjuvant chemotherapy (HR 0.49, 95% CrI 0.23 to 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.

Original language	English
Journal	The Annals of Thoracic Surgery
Volume	107
Issue number	6
Pages (from-to)	1866-1875
ISSN	0003-4975
DOIs	https://doi.org/10.1016/j.athoracsur.2018.11.024
Publication status	Published - Jun 2019

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Zhao, Y., Wang, W., Liang, H., Yang, C.-F. J., D'Amico, T., Ng, C. S. H., Liu, C.-C., Petersen, R. H., Rocco, G., Brunelli, A., Liu, J., He, J., Huang, W., Liang, W., He, J., & AME Thoracic Surgery Collaborative Group (2019). The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis. The Annals of Thoracic Surgery, 107(6), 1866-1875. https://doi.org/10.1016/j.athoracsur.2018.11.024

Zhao, Y, Wang, W, Liang, H, Yang, C-FJ, D'Amico, T, Ng, CSH, Liu, C-C, Petersen, RH, Rocco, G, Brunelli, A, Liu, J, He, J, Huang, W, Liang, W, He, J & AME Thoracic Surgery Collaborative Group 2019, 'The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis', The Annals of Thoracic Surgery, vol. 107, no. 6, pp. 1866-1875. https://doi.org/10.1016/j.athoracsur.2018.11.024

@article{309286c04fd543c6a3982c50c592e310,

title = "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 [HR] 1.14, 95% credible interval [CrI] 0.21 to 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 (HR 0.38, 95% CrI 0.18 to 0.81), surgery plus adjuvant radiotherapy (HR 0.51, 95% CrI 0.29 to 0.92) and potentially surgery plus adjuvant chemotherapy (HR 0.49, 95% CrI 0.23 to 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.",

author = "Yi Zhao and Wei Wang and Hengrui Liang and Yang, {Chi-Fu Jeffrey} and Thomas D'Amico and Ng, {Calvin S H} and Chia-Chuan Liu and Petersen, {Ren{\'e} Horsleben} and Gaetano Rocco and Alessandro Brunelli and Jun Liu and Jiaxi He and Weizhe Huang and Wenhua Liang and Jianxing He and {AME Thoracic Surgery Collaborative Group}",

year = "2019",

month = jun,

doi = "10.1016/j.athoracsur.2018.11.024",

language = "English",

volume = "107",

pages = "1866--1875",

journal = "The Annals of Thoracic Surgery",

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T1 - The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer

T2 - A Network Meta-Analysis

AU - Zhao, Yi

AU - Wang, Wei

AU - Liang, Hengrui

AU - Yang, Chi-Fu Jeffrey

AU - D'Amico, Thomas

AU - Ng, Calvin S H

AU - Liu, Chia-Chuan

AU - Petersen, René Horsleben

AU - Rocco, Gaetano

AU - Brunelli, Alessandro

AU - Liu, Jun

AU - He, Jiaxi

AU - Huang, Weizhe

AU - Liang, Wenhua

AU - He, Jianxing

AU - AME Thoracic Surgery Collaborative Group

PY - 2019/6

Y1 - 2019/6

N2 - 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 [HR] 1.14, 95% credible interval [CrI] 0.21 to 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 (HR 0.38, 95% CrI 0.18 to 0.81), surgery plus adjuvant radiotherapy (HR 0.51, 95% CrI 0.29 to 0.92) and potentially surgery plus adjuvant chemotherapy (HR 0.49, 95% CrI 0.23 to 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.

AB - 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 [HR] 1.14, 95% credible interval [CrI] 0.21 to 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 (HR 0.38, 95% CrI 0.18 to 0.81), surgery plus adjuvant radiotherapy (HR 0.51, 95% CrI 0.29 to 0.92) and potentially surgery plus adjuvant chemotherapy (HR 0.49, 95% CrI 0.23 to 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.

U2 - 10.1016/j.athoracsur.2018.11.024

DO - 10.1016/j.athoracsur.2018.11.024

M3 - Review

C2 - 30557543

SN - 0003-4975

VL - 107

SP - 1866

EP - 1875

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

IS - 6

ER -

The Optimal Treatment for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Network Meta-Analysis

Abstract

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