Meta-analysis Of Different Treatment Modes For Stage ?A-N2 Non-small Cell Lung Cancer

OBJECTIVE:By reviewing and collecting relevant literature data,comparing the effects of different treatment modes on patients with stage ?A-N2 non-small cell lung cancer,providing theoretical basis and clinical guidance for treatment of stage ?A-N2 non-small cell lung cancer.METHODS:Retrieve PubMed,EMBASE,Cochrane Library,Web of Science,Wanfang Data Resource System,and CNKI by computer,supplemented by manual retrieval of related literature,and collect all domestic and foreign publicly published relevant literature before April 2020 which is about stage ?A-N2 non-small cell lung cancer.The literatures were searched according to the set inclusion and exclusion criteria by preliminary screening and reading the title and abstract,then extract relevant information.Statistics software RevMan(V5.3)was used to conduct meta-analysis of the included research data and draw a forest map.RESULTS:1.This article included a total of 10 related literatures,including 2 randomized controlled trials and 8 non-randomized controlled trials.A total of 9720 patients with pathological stage ?A-N2 non-small cell lung cancer were included,of which 4097 patients received postoperative chemoradiotherapy,5623 Patients rec-eived postoperative chemotherapy.The quality of all included literature was generally high.The meta-analysis results suggest that the 1-year overall survival(OR=3.38,95%CI:1.51-7.60,P=0.003)and 3-year overall survival(OR=2.16,95%CI:1.41-3.32,P=0.0004)and 5-year overall survival(OR=1.21,95%CI:1.11-1.32,P<0.00001)were statistica-lly significant.The 5-year local recurrence-free survival(OR=3.64,95%CI:2.48-5.33,P<0.00001)and 5-year distant failure-free survival(OR=2.24,95%CI:1.38-3.64,P=0.001)was also statistically significant in both groups.However,the 5-year disease-free s-urvival(OR=1.35,95%CI:0.93-1.97,P=0.11)have no statistical significance.Subgrou-p analysis suggests that multiple station N2 will benefit more than single station N2 in postoperative chemoradiotherapy for both 5-year overall survival(OR=6.01,95%CI:2.59-13.94,P<0.0001;ORF=1.30,95%CI:0.76-2.22,P=0.34),and 5-year disease-free survival(OR=6.06,95%CI:2.75-13.36,P<0.00001;OR=1.13,95%CI:0.64-1.99,P=0.67).2.A total of 7 related literatures were included in the comparative study of targeted therapy and chemotherapy of stage ?A-N2 non-small cell lung cancer,including 3 randomized controlled trials and 4 non-randomized controlled trials.A total of 591 patients were included,of which 303 patients received targeted therapy,281 patients received chemotherapy.Meta-analysis results suggest that compared with chemotherapy,targeted therapy can improve the 1-year overall survival of patients with stage ?A-N2 non-small cell lung cancer(OR=1.98,95%CI:1.02-3.82,P=0.04),and 1-year disease-free Survival(OR=3.51,95%CI:2.09-5.87,P<0.00001),2-year disease-free survival(OR=3.15,95%CI:2.09-4.75,P<0.00001),3-year disease-free survival(OR=2.53,95%CI:1.41-4.53,P=0.002),and have statistical significance,2-year overall survival(OR=1.75,95%CI:0.82-3.70,P=0.15),3-year overall survival(OR=1.93,95%CI:0.36-10.29,P=0.44)were not statistically significant,and targeted therapy can reduce the incidence of all treatment-related adverse events(OR=0.48,95%CI:0.31-0.74,P=0.0008)and the incidence of grade 3-4 adverse events(OR=0.20,95%CI:0.12-0.32,P<0.00001).CONCLUSION:l.For patients with stage ?A-N2 non-small cell lung cancer,postoperative chemoradiotherapy can improve 1-year,3-years,and 5-years overall survival,5-year local recurrence-free survival and 5-year distant failure-free survival compared with chemotherapy.The 5-year disease-free survival dose not have advantage.The improvement of 5-year overall survival and 5-year disease-free survival of multiple station N2 after postoperative chemoradiotherapy is more significant than single station lymph node metastasis.2.Targeted therapy can improve the 1-year overall survival and 1-year,2-year,and 3-year disease-free survival of patients with stage ?A-N2 non-small cell lung cancer more than chemotherapy,and reduce the incidence of treatment-related adverse events.However,The 2-year and 3-year overall survival have not seen obvious benefits,and the long-term overall survival needs further research.