Prognosis Comparison Between Stereotactic Body Radiation Therapy (Sbrt) And Surgery For Stage I Non-Small Cell Lung Cancer---a Meta Analysis

[Objective]This article is written to review and summarize the development of treatment for stage I non-small cell lung cancer (NSCLC) and ongoing therapy methods. We compare the prognostic evaluation of stage I non-small cell lung cancer (NSCLC) between Stereotactic Body Radiation Therapy (SBRT) and surgery by searching for related clinical trials with the method of meta-analysis.We hope it can provide statistical basis for the treatment choice of stage I NSCLC.[Methods]A systematic search of Cochrane Library, Pubmed, EMBASE, CNKI, VIP and WanFang databases from January,1994to November,2013was performed to identify articles about clinical trials of comparing SBRT and surgery for stage I NSCLC. Search terms were acted as "stage I non-small cell lung cancer","stereotactic body radiation therapy" and "surgery". According to the standard provided by Cochrane Collaboration, two investigators extracted data from retrieved studies independently and graded the articles by Newcastle-Ottawa Scale. The meta-analysis was performed by RevMan5.2recommended by Cochrane Handbook for Systematic Reviews of Interventions. After the identification of heterogeneity, risk ratio (RR) and its respective95%CI (confidence interval) were then estimated separately for combine data including1,2,3,5-year OS,3-year CSS and3-year LCR. Finally forest plots were drawn to display the results of statistic analysis.Sensitivity analysis should be undertaken by funnel plots to evaluate the publication bias. [Results]Six clinical studies were collected, involving325cases in the case group (SBRT group) and703cases in the control group (surgery group).The results of meta-analysis showed that (1)2,3and5-year OS of the surgery group was better than that of the SBRT group [RR=0.76;95%CI:0.67-0.86; P<0.00001],[RR=0.61;95%CI:0.53-0.71; P<0.00001],[RR=0.64;95%CI:0.46-0.89; P=0.009]; there was no significant difference in1and5-year OS;(2) There was no significant difference in3-year CSS between the two groups [RR=1.03;95%CI:0.92-1.15; P=0.09];(3) There was no significant difference in3-year LCR between the two groups [RR=0.95;95%CI:0.69-1.30; P=0.74].[Conclusions]For the treatment of stage I NSCLC, surgery has advantage to SBRT in the overall survival.But in the short (1-year) OS,3-year CSS and3-year LCR, there is little difference between the two therapy methods.Compared to the classic surgery treatment, SBRT has its potential to be an alternative means for stage I NSCLC. Large sample, randomized, prospective clinical trials are still needed to surpport the comparision of the prognosis between the two treament methods.