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

Abstract

BackgroundStandard 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 post-surgical recurrence-free survival (RFS) in NSCLC patients is lacking. Research QuestionWhat is the RFS following surgery in stage I-III NSCLC patients at different timepoints and what factors are associated with RFS? Study Design and MethodsA systematic search was performed in MEDLINE, EMBASE and Cochrane databases between January 2011-June 2021. The primary outcome was RFS at 1-, 2-, 3-, and 5-years post-resection. Single-arm, random-effects meta-analyses calculated effect estimates and 95% confidence intervals (CI). Analyses were stratified by stage/sub-stage per the American Joint Committee on Cancer Staging Manual, and RFS was estimated 1) after pooling studies using 7th or 8th edition staging criteria and 2) among studies using only 8th edition. Meta-regressions were performed to assess associations between RFS and patient demographic/clinical characteristics of interest. ResultsData from 471 studies comprising 1,060 surgical study arms were extracted. RFS estimates from 60,695 patients staged with 7th or 8th edition were analyzed. RFS ranged from 96% at 1-year post-resection 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 8th edition criteria were slightly higher. Older age, higher percentage of males, advancing stage, larger tumor size, and geographical region (North America/Europe vs. Asia) were significantly associated with worse RFS. InterpretationThis study presents a comprehensive assessment of reported RFS from published clinical literature, offering estimates at multiple post-surgical time points and by geographical region. Findings can inform treatment decisions, clinical trial design, and future research to improve outcomes among NSCLC patients. RegistrationProtocol was not registered, but study was conducted based on a pre-specified protocol.