| Objective To systematically appraise the survival results and treatment failure patterns of postoperative radiotherapy(PORT)in patients with completely resected stage IIIA(N2)non-small cell lung cancer(NSCLC).Methods We searched databases including PubMed,The Cochrane Library,CNKI,Wan Fang Database and VIP Database up to June 30,2017,to collect relevant randomized controlled trials or non-randomized controlled trials about PORT in patients with completely resected stage IIIA(N2)NSCLC.Radiotherapy techniques and chemotherapy schemes were not limiting conditions.The patients were limited to completely resected stage IIIA(N2)NSCLC.Patients in the study group were treated with postoperative radiotherapy or postoperative radiochemotherapy,and patients in the control group were treated with postoperative chemotherapy or observation.Two reviewers screened literature according to the inclusion and exclusion criteria,extracted data,and evaluated methodological quality of included studies.Meta-analysis was then performed using Rev Man 5.3 software.Results(1)6 RCTs and 19 n RCTs were retrieved.(2)The meta-analysis results showed that postoperative radiotherapy could significantly improve OS,but a significant heterogeneity was detected among the included studies.Subgroup analysis showed that both postoperative sequential radiochemotherapy and concurrent chemoradiation could not significantly improve OS compared with surgery plus chemotherapy,and the combined effect size were(HR=0.84,95%CI 0.57 to 1.23,P=0.38)and(HR=0.92,95%CI 0.54 to 1.55,P=0.75),respectively.(3)Subgroup analysis based on radiotherapy techniques showed that both conventional radiotherapy and three-dimensional conformal radiotherapy or intensity modulated radiotherapy could significantly improve OS compared with non-PORT group,and the combined effect size were(HR=0.74,95%CI 0.61 to 0.90,P=0.003)and(HR=0.71,95%CI 0.58 to 0.86,P=0.0005),respectively.(4)Meta-analysis of overall survival(OS)Subgroup analysis based on year of publication showed that PORT did not significantly reduce the risk of death after surgery before 2006(HR = 0.70,95% CI 0.44 to 1.12,P = 0.16),but it could significantly reduce the risk of death after 2006(HR=0.76,95%CI 0.68 to 0.86,P<0.00001).(5)Subgroup analysis based on study design showed that PORT could not significantly improve OS compared with non-PORT group in RCTs-subgroup(HR=0.74,95%CI 0.53 to 1.03,P=0.07);but PORT could significantly improve OS in non-RCTS subgroup(HR=0.76,95%CI 0.67 to 0.86,P<0.0001).(6)Meta-analysis of disease-free survival(DFS)/ progression-free survival(PFS): a total of 11 studies evaluated the DFS differences between PORT group and non-PORT group,and the meta-analysis results of REM showed that PORT group could significantly improve DFS compared with non-PORT group(HR=0.66,95%CI 0.60 to 0.72,P<0.00001).(7)Meta-analysis of local recurrence-freesurvival(LRFS): a total of 8 studies evaluated the LRFS differences between PORT group and non-PORT group,and the meta-analysis results of FEM showed that PORT group could significantly improve LRFS compared with non-PORT group(HR=0.33,95%CI 0.24 to 0.46,P<0.00001).(8)Meta-analysis of distant metastasis-free survival(DMFS): a total of 4 studies evaluated the DMFS differences between PORT group and non-PORT group,and the meta-analysis results of REM showed that PORT group could not significantly improve DMFS compared with non-PORT group(HR=0.27,95%CI 0.27 to 1.14,P=0.11).Conclusion Postoperative radiotherapy can significantly reduce the local recurrence rate,improve disease-free survival(DFS)/ progression-free survival and local recurrence-free survival of stage IIIA(N2)NSCLC.With the progress of modern radiotherapy,postoperative radiotherapy could significantly increase in the overall survival rate after 2006.With the development of new radiotherapy techniques,postoperative radiotherapy is expected to improve overall survival in patients with stage IIIA(N2)non-small cell lung cancer.In general,postoperative radiotherapy is feasible and the patient is well tolerated. |
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