The Role Of Surgery In Combination With Radiotherapy/chemotherapy On Limited-stage Small Cell Lung Cancer:a Meta Analysis

Objective: This meta-analysis aims to determine whether surgery in combination with radiotherapy/chemotherapy improves survival in comparison to radiotherapy and/or chemotherapy for L-SCLC.Methods: Pub Med,Pub Med Central,EMBASE,Web of Science,and Cochrane Library were searched for relevant articles.The main outcome were overall survival(OS),reported as hazard ratios(HR),and 95% confidence intervals(CI).Two randomized control trials(RCTs)that included a total of 186 patients were eligible and thirteen retrospective studies that included a total of 41297 patients were eligible.We used the Rev Man 5.3and STATA MP 14.0 to perform the meta-analysis.The heterogeneities among the studies were evaluated by meta-regression analysis.Results: Surgical resection significantly improved OS when compared to non-surgical treatment in retrospective studies(HR=0.56,95% CI: 0.49-0.64,P<0.001),but not in the2 “older” RCTs(HR=0.77,95% CI: 0.32–1.84,P=0.55).In the subgroup analysis for retrospective studies,surgery in combination with radiotherapy/chemotherapy was associated with superior OS in stage I(HR=0.56,95% CI: 0.49–0.64,P<0.001),stage II(HR=0.75,95% CI: 0.57-0.99,P=0.04),and stage III diseases(HR=0.70,95% CI:0.56-0.88,P=0.002).Results of meta-regression analysis demonstrated that the surgical treatment type(P=0.01)was the evident contributor to heterogeneity.Sublobar resection resulted in worse OS than a lobectomy(HR=0.64,95% CI: 0.56-0.74,P<0.001)for patients undergoing surgical resection.Conclusion: Surgery in combination with radiotherapy/chemotherapy appears to be associated with a favorable survival advantage in stage I and selected stage II to III SCLC.Lobectomy is likely to provide superior OS when compared to sublobar resection.Further prospective RCTs are needed to con-firm thesefindings.