Survival after radiofrequency ablation and/or chemotherapy for lung cancer and pulmonary metastases: a systematic review and meta-analysis

Frontiers in Immunology

Immunology

Huilin Yang¹  Benshu Diao¹  Xia Lyu¹  Bingbing Wang¹  Dan Xu¹  Ziyi Yang¹  Yingjun Huang¹  Runzi Zhang¹  Lingyi Huo¹ 

[1] Chengdu Seventh People’s Hospital & Chengdu Tumor Hospital, Chengdu, Sichuan, China;

关键词: lung cancer;    pulmonary metastases;    radiofrequency ablation;    chemotherapy;    systematic review;    meta-analysis;    RFA;   

DOI  :  10.3389/fimmu.2023.1240149

 received in 2023-06-14, accepted in 2023-09-20,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundRadiofrequency ablation (RFA) and chemotherapy are used to treat lung cancer or pulmonary metastases, but no direct comparison of overall survival (OS) has been published. The present study aimed to assess the OS of RFA and/or chemotherapy in patients with lung cancer or pulmonary metastases who were not candidates for surgical resection.MethodsTo identify relevant studies, the following databases were electronically searched from their inception to 31 March 2023: PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid, ScienceDirect, SinoMed, China National Knowledge Infrastructure Database, Chongqing VIP Chinese Science and Technology Periodical Database, Wanfang Database, LILACS, ClinicalTrials.gov, and Chictr.org. Manual retrieval was also conducted. We used published hazard ratios (HRs) if available or estimates from other survival data.ResultsA total of 1,387 participants from 14 trials were included in the final analysis. Patients treated with RFA combined with chemotherapy significantly improved OS compared with those treated with chemotherapy alone [HR 0.50, 95% confidence interval (CI) 0.41–0.61; p < 0.00001], with an absolute difference at 12 months of 29.6% (95% CI 23.7–35.5), at 24 months of 19.2% (95% CI 10.1–28.2), and at 36 months of 22.9% (95% CI 12.0–33.7). No statistically significant difference was observed in the subgroups of case type, cancer type, chemotherapy drugs, and tumor size. The HR for OS with RFA plus chemotherapy vs. RFA alone was 0.53 (95% CI 0.41–0.70; p < 0.00001), corresponding to a 27.1% (95% CI 18.3–35.8), 31.0% (95% CI 19.9–41.9), and 24.9% (95% CI 15.0–34.7) absolute difference in survival at 12 months, 24 months, and 36 months, respectively. Subgroup analysis by geographic region and TNM stage showed that RFA combined with chemotherapy still significantly improved OS compared to RFA. The HR of RFA vs. chemotherapy was 0.98 (95% CI 0.60–1.60; p = 0.94), with an absolute difference at 12 months of 1.4% (95% CI -19.2 to 22.1), at 24 months of 7.8% (95% CI -11.3 to 26.8), and at 36 months of 0.3% (95% CI -13.2 to 13.8). The overall indirect comparison of OS for RFA vs. chemotherapy was 0.95 (95% CI 0.72–1.26; p = 0.74). Data on progression-free survival were not sufficiently reported.ConclusionRFA combined with chemotherapy might be a better treatment option for patients with lung cancer or pulmonary metastases than chemotherapy alone or RFA alone. The comparison between RFA and/or chemotherapy remains to be specifically tested.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=335032, identifier CRD42022335032.

【 授权许可】

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Copyright © 2023 Yang, Lyu, Yang, Wang, Xu, Huo, Zhang, Huang and Diao