Recurrence-Free Survival in Patients With Surgically Resected Non-Small Cell Lung Cancer: A Systematic Literature Review and Meta-Analysis

Ravi Rajaram; Qing Huang; Richard Z Li; Urmila Chandran; Yuxin Zhang; Tony B Amos; George W J Wright; Nicole C Ferko; Iftekhar Kalsekar

doi:10.1016/j.chest.2023.11.042

Recurrence-Free Survival in Patients With Surgically Resected Non-Small Cell Lung Cancer: A Systematic Literature Review and Meta-Analysis

Chest. 2024 May;165(5):1260-1270. doi: 10.1016/j.chest.2023.11.042. Epub 2023 Dec 6.

Authors

Ravi Rajaram¹, Qing Huang², Richard Z Li³, Urmila Chandran⁴, Yuxin Zhang³, Tony B Amos², George W J Wright³, Nicole C Ferko³, Iftekhar Kalsekar²

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: rrajaram@mdanderson.org.
² Johnson & Johnson External Innovation, New Brunswick, NJ.
³ EVERSANA, Burlington, ON, Canada.
⁴ Global Epidemiology & Real-World Data Sciences, Johnson & Johnson, Titusville, NJ.

PMID: 38065405
DOI: 10.1016/j.chest.2023.11.042

Abstract

Background: Standard treatment for early-stage or locoregionally advanced non-small cell lung cancer (NSCLC) includes surgical resection. Recurrence after surgery is commonly reported, but a summary estimate for postsurgical recurrence-free survival (RFS) in patients with NSCLC is lacking.

Research question: What is the RFS after surgery in patients with stage I-III NSCLC at different time points, and what factors are associated with RFS?

Study design and methods: A systematic search was performed in MEDLINE, EMBASE, and Cochrane databases between January 2011 and June 2021. The primary outcome was RFS at 1, 2, 3, and 5 years postresection. Single-arm, random-effects meta-analyses were done to calculate effect estimates and 95% CIs. Analyses were stratified by stage/substage as per the AJCC Cancer Staging Manual, and RFS was estimated (1) after pooling studies, using seventh or eighth edition staging criteria; and (2) among studies using only the eighth edition. Meta-regressions were performed to assess associations between RFS and patient demographic/clinical characteristics of interest.

Results: Data from 471 studies comprising 1,060 surgical study arms were extracted. RFS estimates from 60,695 patients staged with the seventh or eighth edition were analyzed. RFS ranged from 96% at 1 year postresection to 82% at 5 years for stage I, and from 68% at 1 year to 34% at 5 years for stage III. Estimates for patients staged using only eighth edition criteria were slightly higher. Older age, higher percentage of male patients, advancing stage, larger tumor size, and geographic region (North America/Europe vs Asia) were significantly associated with worse RFS.

Interpretation: This study presents a comprehensive assessment of reported RFS from published clinical literature, offering estimates at multiple postsurgical time points and by geographic region. Findings can inform treatment decisions, clinical trial design, and future research to improve outcomes among patients with NSCLC.

Keywords: meta-analysis; non-small cell lung cancer; recurrence; recurrence-free survival; surgery; surgical resection; systematic review.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Non-Small-Cell Lung* / mortality
Carcinoma, Non-Small-Cell Lung* / pathology
Carcinoma, Non-Small-Cell Lung* / surgery
Disease-Free Survival
Humans
Lung Neoplasms* / mortality
Lung Neoplasms* / pathology
Lung Neoplasms* / surgery
Neoplasm Recurrence, Local* / epidemiology
Neoplasm Staging
Pneumonectomy* / methods