Comparison Between Surgery,SBRT And Ablation For Early-Stage Non-small Cell Lung Cancer:a Bayesian Network Meta-analysis

Objective:To investigate and compare the effects of surgery,stereotactic body radiotherapy(SBRT)and percutaneous ablation in patients with early non-small cell lung cancer(NSCLC).Methods:Eligible studies about surgical treatment,SBRT and percutaneous ablation for early NSCLC were retrieved from PubMed,EMBASE,Cochrane Library,Web of Science and Chinese databases such as CNKI,Wanfang,VIP and CBM.The hazard ratio(HR)and 95%confidence interval of the overall survival(OS)rate and progression-free survival(PFS)rate were extracted,and the R software was used to perform the Bayesian network meta-analysis and evaluate the results.Results:38 studies were included,including 2964 patients treated with surgery,1960 patients treated with SBRT and 378 patients treated with percutaneous ablation.Compared with surgery,the pooled OS HR of SBRT was 1.55(95%CI:1.31-1.81),the pooled OS HR of ablation was 1.46(95%CI:1.04-2.05).Regarding PFS,the pooled HR of SBRT was 1.56(95%CI:1.23-1.97),and the pooled HR of ablation was 1.73(95%CI:1.19-2.56).Calculated SUCRA of each treatment,and rank them according to the value of SUCRA.Conclusions:The HR of OS and PFS in patients with surgical treatment is the lowest,with the nearly 100%SUCRA,indicating that surgical treatment has the best effect on patients with early NSCLC.The effects of SBRT and percutaneous puncture are similar,both are worse than surgery.SBRT and Ablation are suitable for inoperable patients.More evidences such as high quality randomized controlled trials are needed to further evaluate the using of SBRT and ablation in operable patients.