Meta-Analysis of Rates and Risk Factors for Local Recurrence in Surgically Resected Patients With NSCLC and...

Area of Science:

• Oncology
• Thoracic Surgery
• Radiotherapy

Background:

• Postoperative radiotherapy (PORT) for non-small cell lung cancer (NSCLC) impacts local failure but not overall survival.
• Significant disparities in locoregional recurrence (LR) rates exist between studies, necessitating an investigation into risk factors and population differences.

Purpose of the Study:

• To conduct a meta-analysis evaluating risk factors for LR in NSCLC patients with pN0-N2 disease.
• To explore potential differences in LR risk between Asian (AP) and non-Asian populations (NAP).

Main Methods:

• Meta-analysis of 87 studies (56 high-quality) of curative NSCLC resection (pT0-N2) published between 2000-2021.
• Pooled relative risks (RR) and 5-year rate estimates were derived using random-effects models for identified risk factors.

Main Results:

• Significant LR risk factors included pN2 vs. pN0 disease (RR 3.01), lymphovascular invasion (RR 1.92), and advanced pT3-4 vs. pT1 stage (RR 1.86).
• High-quality studies identified lymphovascular invasion (RR 1.94), sublobar resection (RR 1.86), and pN1 vs. pN0 (RR 1.84) as key risks.
• Pooled 5-year LR rates were lower in AP (12.0%) than NAP (22.7%), with lower 5-year mortality in AP (24.3%) vs. NAP (45.9%).

Conclusions:

• High-quality evidence for pN2 disease as an LR risk factor is limited; LR appears lower in Asian populations.
• Prospective evaluation of LR factors is needed before further PORT assessment, as recurrence may not solely depend on nodal status.
• Differences in recurrence rates between Asian and non-Asian populations warrant further investigation, as do the impacts of modern therapies.