Role of preoperative chemotherapy for non-small-cell lung cancer: a meta-analysis

The efficacy of preoperative chemotherapy for improving postoperative survival in patients with non-small-cell lung cancer (NSCLC) is controversial. We therefore conducted a meta-analysis of the published phase III randomized clinical trials (RCTs) to quantitatively evaluate the survival benefit of preoperative chemotherapy. After searching the MEDLINE database from 1980 to 2005, five studies were selected for the present meta-analysis. DerSimonian-Laird random effects analysis was used to estimate the hazard ratio (HR) of patients who underwent preoperative chemotherapy at the time points of 1, 3, and 5 years after surgery. A total of 564 patients in stages IB-IIIA served as the data sources. Preoperative chemotherapy was assigned to a total of 281 patients, while surgery alone was assigned to 283 patients. The combined HRs at 1, 3, and 5 years after resection were 0.65 (95% CI, 0.45-0.94), 0.83 (95% CI, 0.74-0.93), and 0.85 (95% CI, 0.70-1.04), respectively, for preoperative chemotherapy compared to surgery alone. The combined survival differences at 1 and 3 years time point were significant, while the difference at 5 years after resection was not significant. When only the 122 stage IIIA patients were analyzed, none of the HR at any time point was significant. In conclusion, the present meta-analysis suggests that the benefit of preoperative chemotherapy for patients with NSCLC is unclear, especially for stage IIIA patients.