Comparative effectiveness for early-stage NSCLC without lymph node involvement based on prospective studies.

BACKGROUND

There is ongoing uncertainty in comparing surgical and nonsurgical therapies, with or without systemic options, in heterogeneous early-stage non-small cell lung cancer without lymph node involvement (eNSCLC-N0).

MATERIALS AND

METHODS

We conducted an integrated evidence synthesis of prospective randomized controlled trials (RCTs) and non-RCTs, covering four databases through September 1, 2024. Treatment effects were evaluated using single-arm, pair-wise, and Bayesian random-effects network meta-analyses. Primary outcomes were overall survival and disease-free survival (DFS); secondary outcomes included recurrence and grade ≥3 adverse events.

RESULTS

This report included 31 clinical trials (24 RCTs) with 12 049 patients. In the network analyses, adjuvant targeted therapy (ATKI) (rank 1) significantly improved DFS compared with mixed radical resection (hazard ratio [HR], 0.21; 95% confidence interval [CI], 0.05-0.90; rank 14; GRADE, very low) in the overall population. For patients with wild-type/unknown EGFR status, stereotactic body radiation therapy (SBRT) plus immune checkpoint inhibitors (rank 1) showed DFS benefit over SBRT alone (HR, 0.17; 95% CI, 0.03-0.83; rank 3; GRADE, high) and was non-inferior to adjuvant platinum-based chemotherapy (HR, 0.18; 95% CI, 0.02-1.65; rank 2; GRADE, very low).

CONCLUSION

These findings suggest the combination of systemic therapies, such as surgery plus ATKI or SBRT plus immunotherapy, superior approaches for patients with eNSCLC-N0 depending on the genomic mutation status and patient tolerability.