Surgery Versus Stereotactic Body Radiotherapy for Early-Stage Non-small Cell Lung Cancer (NSCLC): A Comprehensive...

This systematic review and meta-analysis aimed to compare the efficacy of stereotactic body radiotherapy (SBRT) and surgical resection in early-stage non-small cell lung cancer (NSCLC), focusing on overall survival (OS), cancer-specific survival (CSS), and local control (LC). A comprehensive literature search was conducted using PubMed, Cochrane Library, ScienceDirect, and Google Scholar, and eligible studies were selected according to PRISMA guidelines. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for OS, CSS, and LC using fixed- or random-effects models, and the Newcastle-Ottawa Scale was used to assess study quality. A total of 41 studies involving 88,228 patients (58,366 treated with surgery and 29,862 with SBRT) were included. Surgical resection was significantly associated with improved three-year OS (HR = 1.39; 95% CI: 1.25-1.55; p < 0.00001) compared to SBRT. Subgroup analysis revealed greater survival benefits with lobectomy (HR = 1.50; p < 0.00001) than sublobar resection (HR = 1.27; p = 0.002) or mixed approaches (HR = 1.39; p = 0.007). CSS also favored surgery (HR = 1.22; p = 0.006), particularly lobectomy (HR = 1.46; p = 0.002). LC was comparable between SBRT and surgery (HR = 0.92; p = 0.06), although lobectomy showed a slight advantage (HR = 0.92; p = 0.04). These findings suggest that surgical resection, especially lobectomy, offers superior OS and CSS compared to SBRT in early-stage NSCLC, while LC outcomes are generally equivalent. SBRT remains an effective alternative for medically inoperable patients; however, in operable candidates, surgery should be considered the preferred approach to maximize long-term outcomes.