Adjuvant Chemotherapy Versus Surgery Alone For Stage IB Non-small Cell Lung Cancer:A Systemetic Review And Meta-analysis

OBJECTIVE : Though adjuvant chemotherapy has proven survival benefit for stage II and IIIA Non-Small Cell Lung Cancer(NSCLC),it's efficacy is still uncertain in stage IB patients.Therefore the purpose of this study is to evaluate whether adjuvant chemotherapy is more effective compared to Surgery alone in terms of Overall Survival and Disease free Survival.in stage IB patients.MATERIALS AND METHOD: The relevant articles were search at different database in Pub Med,Cochrane library,Embase and Medline.All the articles published since the inception to April 2016.The Primary Endpoint is Overall Survival(OS)-defined as the time between the date of randomization and death or the last date of follow-up,while the secondary endpoint is the Disease Free Survival(DFS)-defined as the time from randomization to the first date of recurrence or death.RESULTS: Eight Randomized Control Trial(RCT)studies with a total of2497 non-small cell lung cancer patients were included in the analysis.Patients receive Platinum base chemotherapy.The results shows that there are no significant benefit in terms of OS in 5 years for adjuvant chemotherapy(RR=1.01,95% CI,0.85-1.21,p=0.89)and DFS(RR=0.83,95% CI,0.66-1.04)compared with Surgery alone.However the subgroup results of this study shows a statistical significant difference in terms of DFS for patients receiving 6 cycles of Platinum base chemotherapy(RR=0.60,95% CI,0.48-0.76,p<0.0001)compared to 4 or fewer cycles of chemotherapy(RR=0.97,95% CI,0.79-1.19,p=0.77).The other Subgroup in terms of overall Survival did not show any statistical benefit from platinum base adjuvant chemotherapy in stage IB NSCLC.CONCLUSION : Adjuvant chemotherapy after surgery is not beneficial to patients with stage IB in terms of Overall survival,however 6 cycles of adjuvant chemotherapy can improve Disease free survival in 5 years.We still find that our results may not give us a definite conclusion due to high heterogeneity with this study,therefore more RCT's and prospective trials are recommend and trials to be done in the future.