Clinical outcomes of video‐assisted thoracic surgery and stereotactic body radiation therapy for early‐stage non‐small cell lung cancer: A meta‐analysis

BACKGROUND We compared video-assisted thoracoscopic surgery (VATS) lobectomy and stereotactic body radiation therapy (SABR) to explore clinical outcomes in the treatment of patients with early stage NSCLC. METHODS Major medical databases were systematically searched to identify studies on VATS and SBRT published between January 2010 and October 2015. English publications of stage I and II NSCLC with adequate patients and SBRT doses were included. A multivariate random effects model was used to perform meta-analysis to compare overall survival (OS) and disease-free survival (DFS) between VATS and SBRT, adjusting for median age and operable patient numbers. RESULTS Thirteen VATS (3436 patients) and 24 SBRT (4433) studies were eligible. The median age and follow-up duration was 68 years and 42 months for VATS and 74 years and 29.4 months for SBRT patients. After adjusting for the proportion of operable patients and median age, the estimated OS rates at one, two, three, and five years with VATS were 94%, 89%, 84%, and 69% compared with 96%, 94%, 89%, and 82% for SBRT. The estimated DFS rates at one, two, three, and five years with VATS were 97%, 93%, 87%, and 77% compared with 86%, 80%, 73%, and 58% for SBRT. CONCLUSION Before adjustment, patients treated with SBRT had poorer clinical outcomes compared to those treated with VATS. A substantial difference between median age and operability exists between patients treated with SBRT and VATS. After adjusting for these differences, OS and DFS did not differ significantly between the two techniques.