A Propensity-Matched Analysis of Outcomes of Patients with Clinical Stage I Non–Small Cell Lung Cancer Treated surgically or with stereotactic radiotherapy: A Meta-Analysis

ABSTRACT

Objective: The aim of this study was to compare the efficacy between SBRT and surgery based on the Propensity-Matched Analysis. Methods: Publications on comparison SBRT and Surgery for early stage non- small cell lung cancer (NSCLC) from 2011 to 2017 were collected. Propensity score matching was used to achieve comparable treatment hazard ratios of the overall survival (OS), local control survival (LC), regional control survival (RC), loco-regional control survival (LRC), distant control survival (DC), disease-free survival (DFS), and progression-free survival (PFS) between SBRT and Surgery. The major outcomes measures were hazard ratios (HRs). Meta-analysis Revman 5.3 software was used to analyze the combined Pooled HRs using fixed- or random-effects models according to the heterogeneity. Result: Eleven studies met our inclusion criteria. The LC, L-R C, DC, DFS and PFS rates of patients with early-stage lung cancer who were treated with SBRT are equal to surgical results. While, patients with surgery achieved superior OS compared with SBRT. Conclusion: In this study we carried out a meta-analysis, which controls the acceptable level of the efficacy in the propensity score to match patients. The surgery had obvious OS advantages in this meta-analysis. However, these conclusions would be proven by further studies incorporating comorbidity data, and outcomes from randomized control study. The final decision for the optimal treatment of a patient with early-stage NSCLC can be substantiated by a personalized treatment model.

Keywords::

• stereotactic body radiotherapy (SBRT)
• stereotactic ablative radiotherapy (SABR)
• surgery
• stage I non-small cell lung cancer
• meta-analysis
• randomized control trials
• propensity-matched analysis