Meta-analysis Of The Effect Of Preoperative Neoadjuvant Therapy And Radical Chemoradiotherapy On ?A(N2)NSCLC

Objective:To compare the effects of neoadjuvant therapy combined with radical chemoradiotherapv for stage ?A(N2)non-small cell lung cancer(NSCLC).Methods:PubMed,Medline.Ovid.CNKI.Vip and Wanfang databases were retrieved by computer,and supplemented by manual search.The publicly published studies on the treatment of stage ?A(N2)NSCLC with neoadjuvant therapy and radical radiotherapy and chemotherapy were collected from building database to April 2018,and the samples were divided into neoadjuvant therapy combined surgery group and radical chemoradiotherapy group according to the treatment method.Results;A total of 14 studies met the inclusion criteria,including 5 randomized controlled trials(RCTs),9 retrospective case-control studies,with a total sample size of 12713 cases,including 1792 cases in neoadjuvant therapy combined surgery group and 10921 cases in radical chemoradiotherapy group.The 3-year survival rate of the neoadjuvant combination surgery group in the randomized controlled trial was not significantly different from the radical radiotherapy group(OR=0.93.95%CI:0.71-1.22,P=0.61).In the case-control study,the 3-year survival rate of the neoadjuvant combination surgery group was superior to that of the radiotherapy plus chemotherapy group(OR=0.63.95%CI:0.55 to 0.72,P<0.00001).The 5-year survival rate of the neoadjuvant combination surgery group in the randomized controlled trial was not significantly different from the radical chemoradiotherapy group(OR=0.77,95%CI:0.52-1.12,P=0.17).In the case-control study,the 5-year survival rate of the neoadjuvant combination surgery group was better than that of the radical radiotherapy group(OR=0.36,95%CI:0.25-0.51,P<0.00001).Conclusion:Neoadjuvant therapy combined with surgical treatment can make patients with stage III A(N2)NSCLC have longer survival time or achieve cure effect.Pneumonectomy after neoadjuvant therapy may be safe and feasible.Further randomized controlled studies on survival analysis of patients undergoing neoadjuvant therapy combined with surgry,especially pneumonectomy,are of great significance.