"What really works for us?" exploring therapeutic strategies for non-small cell lung cancer: an umbrella review of systematic reviews and meta-analyses.

BACKGROUND

Common non-surgical therapeutic strategies for non-small cell lung cancer (NSCLC) and their efficacy have been reported in many systematic reviews (SRs) and meta-analyses (MAs). However, there is no systematic comparative analysis regarding the relative efficacy of different treatments. Thus, we conducted an umbrella review to provide higher-level evidence for clinical decision-making.

METHODS

A systematic search of PubMed and Web of Science was conducted to identify SRs/MAs focusing on different therapeutic strategies for NSCLC. In total, 34 eligible studies were included. Trial data were systematically extracted and pooled. Methodology quality of evidence was rigorously evaluated using standardized assessment tools.

RESULTS

Thirty-four MAs were synthesized in our study, indicating that targeted therapies and immunotherapies provided the greatest improvements in terms of survival. Other interventions, including chemotherapy, chemoradiotherapy, radiofrequency ablation (RFA), herbal medicine therapies, and combination regimens, also showed favorable survival benefits. Methodological quality assessment using AMSTAR-2 and ROBIS tools revealed some deficiencies, particularly concerning protocol registration, literature search, sensitivity analysis, and bias assessment.

CONCLUSION

Common non-surgical regimens for advanced NSCLC were systematically synthesized, and the comparative efficacy of individual regimens was assessed through pooled analyses. The evidence quality of the included studies was rigorously evaluated based on a multidimensional framework encompassing AMSTAR-2, ROBIS, and GRADE. Among current therapeutic strategies, targeted therapies and immunotherapies provide more benefits, while radiotherapy, RFA, and some combination regimens demonstrate clinically meaningful efficacy. Our study provides high-certainty evidence, which contributes to clinical decision-making and guideline development. Our results highlight the need for standardized protocols in future SRs/MAs to enhance the quality of evidence.