Postoperative UFT-/Tegafur-based Chemotherapy Versus Postoperative Radiotherapy for Early-stage Non-small Cell Lung Cancer：A Systematic Review and Network Meta-analysis

Abstract

Background: Both of UFT-/Tegafur-based postoperative chemotherapy and postoperative radiotherapy have made large progress in treatment of early-stage non-small cell lung cancer. While it is unclear that, whether UFT-/Tegafur-based postoperative chemotherapy is superior to postoperative radiotherapy for early-stage non-small cell lung cancer with no direct evidence. Methods: Electronic databases (Pubmed, embase, cochrane library and clinicaltrials.gov) were searched to obtain relevant studies. This systematic review and meta-analysis is reported in accordance with the Preferred Items for Systematic Reviews and Meta-analysis (PRISMA) Statement and was registered at International Prospective Register of Systematic Reviews (number CRD42018095979). Sensitive analysis was conducted by excluding overweight studies. Funnel plot and egger’s test were performed to conduct publication bias. Results: Twenty-one randomized control trials were included. Our results suggested UFT-/Tegafur-based postoperative chemotherapy could improve overall survival over postoperative radiotherapy [HR=0.69 (0.59-0.80), p=0.000]. But subgroup analysis about stage showed there was no significant difference between them, no matter of stageⅠ,Ⅱ and Ⅲ. As to chemotherapy regime, both UFT-/Tegafur + platinum+vinca alkaloid [HR=0.68 (0.56-0.82), p=0.000] and UFT-/Tegafur only [HR=0.66 (0.54-0.79), p=0.000] were superior to radiotherapy. Subgroup analysis about radiotherapy delivery method and dose showed, significant improvement of chemotherapy over radiotherapy for Cobalt-60 only [HR=0.54 (0.39-0.75), p=0.000], Cobalt-60 and linac [HR=0.69 (0.59-0.81), p=0.000] and ≥45 Gy [HR=0.64 (0.54-0.75), p=0.000], but not for linac only [HR=0.78 (0.60-1.03), p=0.081] and ＜45 Gy [HR=0.86 (0.67-1.11), p=0.241]. Conclusion: UFT-/Tegafur-based postoperative chemotherapy was superior to postoperative radiotherapy for improving overall survival of early-stage non-small cell lung cancer, but it is not always so under certain circumstance, such as RT delivery method and radiation dose. Of course, it is imperative to further explore differences in specific stage, such as ⅠA and ⅠB.