Evaluation of neoadjuvant chemotherapy for stage Ⅲa non-small cell lung cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Zhipeng , SUN Qingchao , ZHANG Haiping , ZONG Liang , REN Luying , ZHANG Yi , ZHANG Changming

The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, P.R.China;

Corresponding author：

ZHANG Changming, Email:

Keywords：

Neoadjuvant; stage IIIa; non-small cell lung cancer; meta-analysis

DOI：

10.7507/1007-4848.201712003

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the profitability and efficacy of neoadjuvant chemotherapy in patients with stage Ⅲa non-small cell lung cancer. Methods Randomized controlled trials (RCT) on neoadjuvant chemotherapy for stage Ⅲa non-small cell lung cancer were collected from WangFang Data database, Web of Science, PubMed, EMbase, CNKI, The Cochrane Library, VIP and CBM databases. From building to October 2017. After two independent reviewers screened the literature, extracted data and assessed the risk of being included in the study, Meta-analysis was performed using RevMan 5.3 software. Results A total of 15 RCT were included, including 1899 non-small cell lung cancer patients. The results of Meta analysis showed that the resection rate of R0 in neoadjuvant chemotherapy group was significantly higher than that in control group (OR=2.04, 95%CI 1.52 to 2.74, P<0.05), and there was no significant difference in postoperative complications between two groups (OR=1.23, 95%CI 0.89 to 1.69, P=0.22). In terms of survival rate, the neoadjuvant chemotherapy group could improve patients for one year (OR=1.38, 95%CI 1.01 to 1.88, P=0.04), three years (OR=1.57, 95%CI 1.16 to 2.12, P=0.004) and 5 years survival rate (OR=2.09, 95%CI 1.24 to 3.53, P=0.005) significance of learning. Conclusion Compared with the control group, neoadjuvant chemotherapy can improve the surgical R0 resection rate and the one, three and five year survival rate of patients with stage Ⅲa non-small cell lung cancer without increasing the postoperative complications. Due to the quantity and quality limitations of the included studies, the above conclusion still needs to be verified by more high-quality research.

1.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3.	Piperis M, Tsoukalas N. Stereotactic body radiation therapy and surgery for early stage non-small cell lung cancer. J Invest Surg, 2017: 1-3.
4.	Berkovic P, Paelinck L, Gulyban A, et al. Adaptive radiotherapy for locally advanced non-small cell lung cancer: dosimetric gain and treatment outcome prediction. Acta Oncol, 2017, 56(11): 1656-1659.
5.	Pless M, Stupp R, Ris HB, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet, 2015, 386(9998): 1049-1056.
6.	Zhao X, Wen X, Wei W, et al. Predictors for the efficacy of Endostar combined with neoadjuvant chemotherapy for stage IIIA (N2) NSCLC. Cancer Biomark, 2017, 21(1): 169-177.
7.	Savic M, Kontic M, Ercegovac M, et al. Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non-small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience. Thorac Cancer, 2017, 8(5): 393-401.
8.	Wang HH, Deng L, Wen QL, et al. Early postoperative radiotherapy is associated with improved outcomes over late postoperative radiotherapy in the management of completely resected (R0) Stage IIIA-N2 non-small cell lung cancer. Oncotarget, 2017, 8(38): 62998-63013.
9.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at:http://handbook.cochrane.org.
10.	唐翠萍, 秦思, 伍万春, 等. Ⅲa 期非小细胞肺癌新辅助化疗的疗效分析及应用价值.中国肺癌杂志, 2017, 20(2): 100-106.
11.	陈树兴, 陈新富, 郭立人, 等.ⅢA 期非小细胞肺癌患者术前新辅助化疗的临床分析.福建医药杂志, 2013, 35(6): 118-120.
12.	温永富, 宋旭东. Ⅲa 期非小细胞肺癌新辅助化疗的临床评价.中国综合临床, 2005, 21(7): 624-625.
13.	石鹏飞, 张晓明. MVP 方案新辅助化疗治疗ⅢA 期非小细胞肺癌的疗效观察.实用癌症杂志, 2016, 31(5): 769-771.
14.	张国庆, 韩峰, 高胜利, 等.新辅助化疗对 165 例 Ⅲa 期非小细胞肺癌患者术后生存的影响分析. 肿瘤研究与临床, 2007, 19(7): 470-473.
15.	周明, 王远东, 邵中夫, 等. 新辅助化疗对 Ⅲa 期非小细胞肺癌手术及围术期并发症的影响.广东医学, 2004, 25(9): 1053-1054.
16.	李勇生, 杨文东, 黄宇康, 等.新辅助化疗对ⅢA 期非小细胞肺癌手术疗效的影响. 中国基层医药, 2006, 13(2): 201-202.
17.	李坚, 俞力超, 张德厚, 等.新辅助化疗对提高ⅢA 期非小细胞肺癌手术切除率的作用.中国肿瘤临床与康复, 2002, 9(6): 67-69.
18.	游庆军, 王嘉玮, 蒋锡初, 等.新辅助化疗在 Ⅲa 期非小细胞肺癌治疗中的应用.现代肿瘤医学, 2006, 14(7): 827-828.
19.	王嘉玮, 游庆军, 蒋锡初, 等.新辅助化疗在 Ⅲa 期肺癌治疗中的应用. 实用全科医学, 2006, 4(1): 15-16.
20.	张艳峰, 苏文中.新辅助化疗治疗 Ⅲa 期非小细胞肺癌的临床观察. 中国继续医学教育, 2015, (3): 66-67.
21.	李宇晖, 高爽, 庄思敏, 等.紫杉醇加顺铂的新辅助化疗对提高ⅢA 期非小细胞肺癌手术切除率的临床作用. 岭南现代临床外科, 2004, 4(3): 231-232.
22.	张立新, 王启文, 曲明江, 等.新辅助化疗对 IIIA 期非小细胞肺癌外科治疗的影响. 中国误诊学杂志, 2011, 11(30): 7401-7402.
23.	Milroy R, Macbeth F. Neoadjuvant chemotherapy in stage IIIa non-small cell lung cancer. Thorax, 1995, 50 Suppl 1: S25-S30.
24.	Nagai K, Tsuchiya R, Mori T, et al. A randomized trial comparing induction chemotherapy followed by surgery with surgery alone for patients with stage IIIA N2 non-small cell lung cancer (JCOG 9209). J Thorac Cardiovasc Surg, 2003, 125(2): 254-260.
25.	Misumi K, Harada H, Tsubokawa N, et al. Clinical benefit of neoadjuvant chemoradiotherapy for the avoidance of pneumonectomy; assessment in 12 consecutive centrally located non-small cell lung cancers. Gen Thorac Cardiovasc Surg, 2017, 65(7): 392-399.
26.	Tang C, Qin S, Wu W, et al. Efficacy and Potential Application of Neoadjuvant Chemotherapy in Patients with IIIa Stage Non-small Cell Lung Cancer. Zhongguo Fei Ai Za Zhi, 2017, 20(2): 100-106.
27.	Wang Y, Wang X, Yan S, et al. Progress of neoadjuvant therapy combined with surgery in non-small cell lung cancer. Zhongguo Fei Ai Za Zhi, 2017, 20(5): 352-360.
28.	Bruzzi JF, Komaki R, Walsh GL, et al. Imaging of non-small cell lung cancer of the superior sulcus: part 1: anatomy, clinical manifestations, and management. Radiographics, 2008, 28(2): 551-560.
29.	Duan X, Liu Z, Xu S. Research progresses of circulating tumor cells in diagnosis and treatment of early lung cancer. zhongguo fei ai za zhi, 2017, 20(10): 703-709.
30.	Spaggiari L, Casiraghi M, Guarize J, et al. Outcome of Patients With pN2 " Potentially Resectable” Nonsmall Cell Lung Cancer Who Underwent Surgery After Induction Chemotherapy. Semin Thorac Cardiovasc Surg, 2016, 28(2): 593-602.
31.	Francolini G, Ferrari K, Scotti V. Neoadjuvant approach for nonsmall cell lung cancer: overview of the current issues. Curr Opin Oncol, 2017, 29(2): 123-128.
32.	Zhu J, Zhang HP, Jiang S, et al. Neoadjuvant chemotherapy by bronchial arterial infusion in patients with unresectable stage III squamous cell lung cancer. Ther Adv Respir Dis, 2017, 11(8): 301-309.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3. Piperis M, Tsoukalas N. Stereotactic body radiation therapy and surgery for early stage non-small cell lung cancer. J Invest Surg, 2017: 1-3.
4. Berkovic P, Paelinck L, Gulyban A, et al. Adaptive radiotherapy for locally advanced non-small cell lung cancer: dosimetric gain and treatment outcome prediction. Acta Oncol, 2017, 56(11): 1656-1659.
5. Pless M, Stupp R, Ris HB, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet, 2015, 386(9998): 1049-1056.
6. Zhao X, Wen X, Wei W, et al. Predictors for the efficacy of Endostar combined with neoadjuvant chemotherapy for stage IIIA (N2) NSCLC. Cancer Biomark, 2017, 21(1): 169-177.
7. Savic M, Kontic M, Ercegovac M, et al. Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non-small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience. Thorac Cancer, 2017, 8(5): 393-401.
8. Wang HH, Deng L, Wen QL, et al. Early postoperative radiotherapy is associated with improved outcomes over late postoperative radiotherapy in the management of completely resected (R0) Stage IIIA-N2 non-small cell lung cancer. Oncotarget, 2017, 8(38): 62998-63013.
9. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at:http://handbook.cochrane.org.
10. 唐翠萍, 秦思, 伍万春, 等. Ⅲa 期非小细胞肺癌新辅助化疗的疗效分析及应用价值.中国肺癌杂志, 2017, 20(2): 100-106.
11. 陈树兴, 陈新富, 郭立人, 等.ⅢA 期非小细胞肺癌患者术前新辅助化疗的临床分析.福建医药杂志, 2013, 35(6): 118-120.
12. 温永富, 宋旭东. Ⅲa 期非小细胞肺癌新辅助化疗的临床评价.中国综合临床, 2005, 21(7): 624-625.
13. 石鹏飞, 张晓明. MVP 方案新辅助化疗治疗ⅢA 期非小细胞肺癌的疗效观察.实用癌症杂志, 2016, 31(5): 769-771.
14. 张国庆, 韩峰, 高胜利, 等.新辅助化疗对 165 例 Ⅲa 期非小细胞肺癌患者术后生存的影响分析. 肿瘤研究与临床, 2007, 19(7): 470-473.
15. 周明, 王远东, 邵中夫, 等. 新辅助化疗对 Ⅲa 期非小细胞肺癌手术及围术期并发症的影响.广东医学, 2004, 25(9): 1053-1054.
16. 李勇生, 杨文东, 黄宇康, 等.新辅助化疗对ⅢA 期非小细胞肺癌手术疗效的影响. 中国基层医药, 2006, 13(2): 201-202.
17. 李坚, 俞力超, 张德厚, 等.新辅助化疗对提高ⅢA 期非小细胞肺癌手术切除率的作用.中国肿瘤临床与康复, 2002, 9(6): 67-69.
18. 游庆军, 王嘉玮, 蒋锡初, 等.新辅助化疗在 Ⅲa 期非小细胞肺癌治疗中的应用.现代肿瘤医学, 2006, 14(7): 827-828.
19. 王嘉玮, 游庆军, 蒋锡初, 等.新辅助化疗在 Ⅲa 期肺癌治疗中的应用. 实用全科医学, 2006, 4(1): 15-16.
20. 张艳峰, 苏文中.新辅助化疗治疗 Ⅲa 期非小细胞肺癌的临床观察. 中国继续医学教育, 2015, (3): 66-67.
21. 李宇晖, 高爽, 庄思敏, 等.紫杉醇加顺铂的新辅助化疗对提高ⅢA 期非小细胞肺癌手术切除率的临床作用. 岭南现代临床外科, 2004, 4(3): 231-232.
22. 张立新, 王启文, 曲明江, 等.新辅助化疗对 IIIA 期非小细胞肺癌外科治疗的影响. 中国误诊学杂志, 2011, 11(30): 7401-7402.
23. Milroy R, Macbeth F. Neoadjuvant chemotherapy in stage IIIa non-small cell lung cancer. Thorax, 1995, 50 Suppl 1: S25-S30.
24. Nagai K, Tsuchiya R, Mori T, et al. A randomized trial comparing induction chemotherapy followed by surgery with surgery alone for patients with stage IIIA N2 non-small cell lung cancer (JCOG 9209). J Thorac Cardiovasc Surg, 2003, 125(2): 254-260.
25. Misumi K, Harada H, Tsubokawa N, et al. Clinical benefit of neoadjuvant chemoradiotherapy for the avoidance of pneumonectomy; assessment in 12 consecutive centrally located non-small cell lung cancers. Gen Thorac Cardiovasc Surg, 2017, 65(7): 392-399.
26. Tang C, Qin S, Wu W, et al. Efficacy and Potential Application of Neoadjuvant Chemotherapy in Patients with IIIa Stage Non-small Cell Lung Cancer. Zhongguo Fei Ai Za Zhi, 2017, 20(2): 100-106.
27. Wang Y, Wang X, Yan S, et al. Progress of neoadjuvant therapy combined with surgery in non-small cell lung cancer. Zhongguo Fei Ai Za Zhi, 2017, 20(5): 352-360.
28. Bruzzi JF, Komaki R, Walsh GL, et al. Imaging of non-small cell lung cancer of the superior sulcus: part 1: anatomy, clinical manifestations, and management. Radiographics, 2008, 28(2): 551-560.
29. Duan X, Liu Z, Xu S. Research progresses of circulating tumor cells in diagnosis and treatment of early lung cancer. zhongguo fei ai za zhi, 2017, 20(10): 703-709.
30. Spaggiari L, Casiraghi M, Guarize J, et al. Outcome of Patients With pN2 " Potentially Resectable” Nonsmall Cell Lung Cancer Who Underwent Surgery After Induction Chemotherapy. Semin Thorac Cardiovasc Surg, 2016, 28(2): 593-602.
31. Francolini G, Ferrari K, Scotti V. Neoadjuvant approach for nonsmall cell lung cancer: overview of the current issues. Curr Opin Oncol, 2017, 29(2): 123-128.
32. Zhu J, Zhang HP, Jiang S, et al. Neoadjuvant chemotherapy by bronchial arterial infusion in patients with unresectable stage III squamous cell lung cancer. Ther Adv Respir Dis, 2017, 11(8): 301-309.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesEvaluation of neoadjuvant chemotherapy for stage Ⅲa non-small cell lung cancer: A systematic review and meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Format

Content