Efficacy of induction chemotherapy or chemoradiotherapy followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small cell lung cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Hua ¹ , HU Wenteng ² , MA Minjie ² ,  HAN Biao ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, P. R. China;
2. The First Hospital of Lanzhou University, Lanzhou, 730030, P. R. China;

Corresponding author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Radiotherapy; surgical treatment; stage ⅢA-N2 non-small cell lung cancer; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202012040

Video：

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Objective To systematically evaluate the efficacy of neoadjuvant chemoradiotherapy or chemotherapy followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small cell lung cancer (NSCLC).Methods We searched PubMed, EMbase, Web of Science and The Cochrane Library to collect clinical studies on the efficacy comparison between neoadjuvant chemoradiotherapy or chemotherapy followed by surgery and definitive chemoradiation in stage ⅢA-N2 NSCLC from inception to September 2022. The meta-analysis was performed by using RevMan 5.3 software.Results A total of 9 studies (3 randomized controlled trials and 6 retrospective cohort studies) with 12 801 patients were included. The results of meta-analysis showed that there was no statistical difference in the progression-free survival rate between the inductive treatment followed by surgery (including lobectomy and pneumonectomy) and definitive chemoradiation (HR=0.99, 95%CI 0.86-1.15, P=0.91). Compared with definitive chemoradiation, the overall survival (OS) rate in the inductive treatment followed by surgery (including lobectomy and pneumonectomy) was lower (HR=1.24, 95%CI 1.09-1.42, P=0.001), while the OS rate in the inductive treatment followed by lobectomy was higher (HR=0.55, 95%CI 0.51-0.61, P<0.000 01). And the local recurrence rate in the inductive treatment followed by surgery was reduced (OR=0.44, 95%CI 0.36-0.55, P<0.000 01).Conclusion Neoadjuvant chemoradiotherapy or chemotherapy followed by lobectomy is superior to definitive chemoradiation in OS and it has a lower local recurrence rate, so lobectomy should be one of the multidisciplinary treatments for selected ⅢA-N2 NSCLC patients.

Citation： HE Hua, HU Wenteng, MA Minjie, HAN Biao. Efficacy of induction chemotherapy or chemoradiotherapy followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small cell lung cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 133-139. doi: 10.7507/1007-4848.202012040 Copy

1.	Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(8): 706-714.
2.	Mountain CF. Revisions in the international system for staging lung cancer. Chest, 1997, 111(6): 1710-1717.
3.	Martini N, Flehinger BJ. The role of surgery in N2 lung cancer. Surg Clin North Am, 1987, 67(5): 1037-1049.
4.	Andre F, Grunenwald D, Pignon JP, et al. Survival of patients with resected N2 non-small-cell lung cancer: Evidence for a subclassification and implications. J Clin Oncol, 2000, 18(16): 2981-2989.
5.	Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage ⅢA non-small-cell lung cancer. J Natl Cancer Inst, 1994, 86(9): 673-680.
6.	Rosell R, Gómez-Codina J, Camps C, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med, 1994, 330(3): 153-158.
7.	Nagai K, Tsuchiya R, Mori T, et al. A randomized trial comparing induction chemotherapy followed by surgery with surgery alone for patients with stage ⅢA N2 non-small cell lung cancer (JCOG 9209). J Thorac Cardiovasc Surg, 2003, 125(2): 254-260.
8.	Marino P, Preatoni A, Cantoni A. Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages Ⅲa and Ⅲb nonsmall cell lung cancer. A meta-analysis. Cancer, 1995, 76(4): 593-601.
9.	Aupérin A, Le Péchoux C, Rolland E, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol, 2010, 28(13): 2181-2190.
10.	Elias AD, Kumar P, Herndon J, et al. Radiotherapy versus chemotherapy plus radiotherapy in surgically treated ⅢA N2 non-small-cell lung cancer. Clin Lung Cancer, 2002, 4(2): 95-103.
11.	Pritchard RS, Anthony SP. Chemotherapy plus radiotherapy compared with radiotherapy alone in the treatment of locally advanced, unresectable, non-small-cell lung cancer. A meta-analysis. Ann Intern Med, 1996, 125(9): 723-729.
12.	Robinson LA, Ruckdeschel JC, Wagner H, et al. Treatment of non-small cell lung cancer-stage ⅢA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 243S-265S.
13.	Lim E, Baldwin D, Beckles M, et al. Guidelines on the radical management of patients with lung cancer. Thorax, 2010, 65(Suppl 3): iii1-iii27.
14.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med, 2009, 6(7): e1000097.
15.	Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8: 16.
16.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17.	Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
18.	Kappers I, van Sandick JW, Burgers SA, et al. Surgery after induction chemotherapy in stage ⅢA-N2 non-small cell lung cancer: Why pneumonectomy should be avoided. Lung Cancer, 2010, 68(2): 222-227.
19.	Koshy M, Fedewa SA, Malik R, et al. Improved survival associated with neoadjuvant chemoradiation in patients with clinical stage ⅢA(N2) non-small-cell lung cancer. J Thorac Oncol, 2013, 8(7): 915-922.
20.	Aggarwal C, Li L, Borghaei H, et al. Multidisciplinary therapy of stage ⅢA non-small-cell lung cancer: Long-term outcome of chemoradiation with or without surgery. Cancer Control, 2014, 21(1): 57-62.
21.	Darling GE, Li F, Patsios D, et al. Neoadjuvant chemoradiation and surgery improves survival outcomes compared with definitive chemoradiation in the treatment of stage ⅢA N2 non-small-cell lung cancer. Eur J Cardiothorac Surg, 2015, 48(5): 684-690.
22.	Couñago F, Rodriguez de Dios N, Montemuiño S, et al. Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society). Lung Cancer, 2018, 118: 119-127.
23.	Rajaram R, Correa AM, Xu T, et al. Locoregional control, overall survival, and disease-free survival in stage ⅢA (N2) non-small-cell lung cancer: Analysis of resected and unresected patients. Clin Lung Cancer, 2020, 21(4): e294-e301.
24.	van Meerbeeck JP, Kramer GW, Van Schil PE, et al. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage ⅢA-N2 non-small-cell lung cancer. J Natl Cancer Inst, 2007, 99(6): 442-450.
25.	Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage Ⅲ non-small-cell lung cancer: A phase Ⅲ randomised controlled trial. Lancet, 2009, 374(9687): 379-386.
26.	Eberhardt WE, Pöttgen C, Gauler TC, et al. Phase Ⅲ study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage ⅢA(N2) and selected ⅢB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol, 2015, 33(35): 4194-4201.
27.	Shah AA, Berry MF, Tzao C, et al. Induction chemoradiation is not superior to induction chemotherapy alone in stage ⅢA lung cancer. Ann Thorac Surg, 2012, 93(6): 1807-1812.
28.	Tong S, Qin Z, Wan M, et al. Induction chemoradiotherapy versus induction chemotherapy for potentially resectable stage ⅢA (N2) non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2428-2436.
29.	陈新林, 胡月, 郎建英, 等. RevMan、Stata 和 R 软件在生存资料 Meta 分析的应用. 中国循证医学杂志, 2016, 16(6): 736-740.
30.	McGovern EM, Trastek VF, Pairolero PC, et al. Completion pneumonectomy: Indications, complications, and results. Ann Thorac Surg, 1988, 46(2): 141-146.
31.	Beck N, Van Brakel TJ, Smit HJM, et al. Pneumonectomy for lung cancer treatment in the Netherlands: Between-hospital variation and outcomes. World J Surg, 2020, 44(1): 285-294.
32.	Harmouchi H, Sani R, Belliraj L, et al. Pneumonectomy for non-tumoral diseases: Etiologies and follow-up in 38 cases. Asian Cardiovasc Thorac Ann, 2019, 27(4): 298-301.
33.	Pricopi C, Mordant P, Rivera C, et al. Postoperative morbidity and mortality after pneumonectomy: A 30-year experience of 2064 consecutive patients. Interact Cardiovasc Thorac Surg, 2015, 20(3): 316-321.
34.	Xu XL, Dan L, Chen W, et al. Neoadjuvant chemoradiotherapy or chemotherapy followed by surgery is superior to that followed by definitive chemoradiation or radiotherapy in stage ⅢA (N2) nonsmall-cell lung cancer: A meta-analysis and system review. Onco Targets Ther, 2016, 9: 845-853.
35.	Hofmann HS, Braess J, Leipelt S, et al. Multimodality therapy in subclassified stage ⅢA-N2 non-small cell lung cancer patients according to the Robinson classification: Heterogeneity and management. J Thorac Dis, 2018, 10(6): 3585-3594.
36.	Joosten PJM, Damhuis RAM, van Diessen JNA, et al. Results of neoadjuvant chemo(radio)therapy and resection for stage ⅢA non-small cell lung cancer in The Netherlands. Acta Oncol, 2020, 59(7): 748-752.
37.	Girard N, Mornex F, Douillard JY, et al. Is neoadjuvant chemoradiotherapy a feasible strategy for stage ⅢA-N2 non-small cell lung cancer? Mature results of the randomized IFCT-0101 phase Ⅱ trial. Lung Cancer, 2010, 69(1): 86-93.
38.	Barnett SA, Rusch VW, Zheng J, et al. Contemporary results of surgical resection of non-small cell lung cancer after induction therapy: A review of 549 consecutive cases. J Thorac Oncol, 2011, 6(9): 1530-1536.
39.	Inoue M, Sawabata N, Takeda S, et al. Results of surgical intervention for p-stage ⅢA (N2) non-small cell lung cancer: acceptable prognosis predicted by complete resection in patients with single N2 disease with primary tumor in the upper lobe. J Thorac Cardiovasc Surg, 2004, 127(4): 1100-1106.
40.	Matsuguma H, Nakahara R, Ishikawa Y, et al. Postoperative radiotherapy for patients with completely resected pathological stage ⅢA-N2 non-small cell lung cancer: Focusing on an effect of the number of mediastinal lymph node stations involved. Interact Cardiovasc Thorac Surg, 2008, 7(4): 573-577.
41.	Bueno R, Richards WG, Swanson SJ, et al. Nodal stage after induction therapy for stage ⅢA lung cancer determines patient survival. Ann Thorac Surg, 2000, 70(6): 1826-1831.
42.	de Cabanyes Candela S, Detterbeck FC. A systematic review of restaging after induction therapy for stage Ⅲa lung cancer: Prediction of pathologic stage. J Thorac Oncol, 2010, 5(3): 389-398.
43.	Cerfolio RJ, Bryant AS, Ojha B. Restaging patients with N2 (stage Ⅲa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: A prospective study. J Thorac Cardiovasc Surg, 2006, 131(6): 1229-1235.
44.	De Waele M, Hendriks J, Lauwers P, et al. Restaging the mediastinum in non-small cell lung cancer after induction therapy: Non-invasive versus invasive procedures. Acta Chir Belg, May-Jun 2011, 111(3): 161-164.
45.	Annema JT, Veseliç M, Versteegh MI, et al. Mediastinal restaging: EUS-FNA offers a new perspective. Lung Cancer, 2003, 42(3): 311-318.
46.	De Waele M, Serra-Mitjans M, Hendriks J, et al. Accuracy and survival of repeat mediastinoscopy after induction therapy for non-small cell lung cancer in a combined series of 104 patients. Eur J Cardiothorac Surg, 2008, 33(5): 824-828.

1. Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(8): 706-714.
2. Mountain CF. Revisions in the international system for staging lung cancer. Chest, 1997, 111(6): 1710-1717.
3. Martini N, Flehinger BJ. The role of surgery in N2 lung cancer. Surg Clin North Am, 1987, 67(5): 1037-1049.
4. Andre F, Grunenwald D, Pignon JP, et al. Survival of patients with resected N2 non-small-cell lung cancer: Evidence for a subclassification and implications. J Clin Oncol, 2000, 18(16): 2981-2989.
5. Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage ⅢA non-small-cell lung cancer. J Natl Cancer Inst, 1994, 86(9): 673-680.
6. Rosell R, Gómez-Codina J, Camps C, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med, 1994, 330(3): 153-158.
7. Nagai K, Tsuchiya R, Mori T, et al. A randomized trial comparing induction chemotherapy followed by surgery with surgery alone for patients with stage ⅢA N2 non-small cell lung cancer (JCOG 9209). J Thorac Cardiovasc Surg, 2003, 125(2): 254-260.
8. Marino P, Preatoni A, Cantoni A. Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages Ⅲa and Ⅲb nonsmall cell lung cancer. A meta-analysis. Cancer, 1995, 76(4): 593-601.
9. Aupérin A, Le Péchoux C, Rolland E, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol, 2010, 28(13): 2181-2190.
10. Elias AD, Kumar P, Herndon J, et al. Radiotherapy versus chemotherapy plus radiotherapy in surgically treated ⅢA N2 non-small-cell lung cancer. Clin Lung Cancer, 2002, 4(2): 95-103.
11. Pritchard RS, Anthony SP. Chemotherapy plus radiotherapy compared with radiotherapy alone in the treatment of locally advanced, unresectable, non-small-cell lung cancer. A meta-analysis. Ann Intern Med, 1996, 125(9): 723-729.
12. Robinson LA, Ruckdeschel JC, Wagner H, et al. Treatment of non-small cell lung cancer-stage ⅢA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 243S-265S.
13. Lim E, Baldwin D, Beckles M, et al. Guidelines on the radical management of patients with lung cancer. Thorax, 2010, 65(Suppl 3): iii1-iii27.
14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med, 2009, 6(7): e1000097.
15. Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8: 16.
16. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
18. Kappers I, van Sandick JW, Burgers SA, et al. Surgery after induction chemotherapy in stage ⅢA-N2 non-small cell lung cancer: Why pneumonectomy should be avoided. Lung Cancer, 2010, 68(2): 222-227.
19. Koshy M, Fedewa SA, Malik R, et al. Improved survival associated with neoadjuvant chemoradiation in patients with clinical stage ⅢA(N2) non-small-cell lung cancer. J Thorac Oncol, 2013, 8(7): 915-922.
20. Aggarwal C, Li L, Borghaei H, et al. Multidisciplinary therapy of stage ⅢA non-small-cell lung cancer: Long-term outcome of chemoradiation with or without surgery. Cancer Control, 2014, 21(1): 57-62.
21. Darling GE, Li F, Patsios D, et al. Neoadjuvant chemoradiation and surgery improves survival outcomes compared with definitive chemoradiation in the treatment of stage ⅢA N2 non-small-cell lung cancer. Eur J Cardiothorac Surg, 2015, 48(5): 684-690.
22. Couñago F, Rodriguez de Dios N, Montemuiño S, et al. Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society). Lung Cancer, 2018, 118: 119-127.
23. Rajaram R, Correa AM, Xu T, et al. Locoregional control, overall survival, and disease-free survival in stage ⅢA (N2) non-small-cell lung cancer: Analysis of resected and unresected patients. Clin Lung Cancer, 2020, 21(4): e294-e301.
24. van Meerbeeck JP, Kramer GW, Van Schil PE, et al. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage ⅢA-N2 non-small-cell lung cancer. J Natl Cancer Inst, 2007, 99(6): 442-450.
25. Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage Ⅲ non-small-cell lung cancer: A phase Ⅲ randomised controlled trial. Lancet, 2009, 374(9687): 379-386.
26. Eberhardt WE, Pöttgen C, Gauler TC, et al. Phase Ⅲ study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage ⅢA(N2) and selected ⅢB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol, 2015, 33(35): 4194-4201.
27. Shah AA, Berry MF, Tzao C, et al. Induction chemoradiation is not superior to induction chemotherapy alone in stage ⅢA lung cancer. Ann Thorac Surg, 2012, 93(6): 1807-1812.
28. Tong S, Qin Z, Wan M, et al. Induction chemoradiotherapy versus induction chemotherapy for potentially resectable stage ⅢA (N2) non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2428-2436.
29. 陈新林, 胡月, 郎建英, 等. RevMan、Stata 和 R 软件在生存资料 Meta 分析的应用. 中国循证医学杂志, 2016, 16(6): 736-740.
30. McGovern EM, Trastek VF, Pairolero PC, et al. Completion pneumonectomy: Indications, complications, and results. Ann Thorac Surg, 1988, 46(2): 141-146.
31. Beck N, Van Brakel TJ, Smit HJM, et al. Pneumonectomy for lung cancer treatment in the Netherlands: Between-hospital variation and outcomes. World J Surg, 2020, 44(1): 285-294.
32. Harmouchi H, Sani R, Belliraj L, et al. Pneumonectomy for non-tumoral diseases: Etiologies and follow-up in 38 cases. Asian Cardiovasc Thorac Ann, 2019, 27(4): 298-301.
33. Pricopi C, Mordant P, Rivera C, et al. Postoperative morbidity and mortality after pneumonectomy: A 30-year experience of 2064 consecutive patients. Interact Cardiovasc Thorac Surg, 2015, 20(3): 316-321.
34. Xu XL, Dan L, Chen W, et al. Neoadjuvant chemoradiotherapy or chemotherapy followed by surgery is superior to that followed by definitive chemoradiation or radiotherapy in stage ⅢA (N2) nonsmall-cell lung cancer: A meta-analysis and system review. Onco Targets Ther, 2016, 9: 845-853.
35. Hofmann HS, Braess J, Leipelt S, et al. Multimodality therapy in subclassified stage ⅢA-N2 non-small cell lung cancer patients according to the Robinson classification: Heterogeneity and management. J Thorac Dis, 2018, 10(6): 3585-3594.
36. Joosten PJM, Damhuis RAM, van Diessen JNA, et al. Results of neoadjuvant chemo(radio)therapy and resection for stage ⅢA non-small cell lung cancer in The Netherlands. Acta Oncol, 2020, 59(7): 748-752.
37. Girard N, Mornex F, Douillard JY, et al. Is neoadjuvant chemoradiotherapy a feasible strategy for stage ⅢA-N2 non-small cell lung cancer? Mature results of the randomized IFCT-0101 phase Ⅱ trial. Lung Cancer, 2010, 69(1): 86-93.
38. Barnett SA, Rusch VW, Zheng J, et al. Contemporary results of surgical resection of non-small cell lung cancer after induction therapy: A review of 549 consecutive cases. J Thorac Oncol, 2011, 6(9): 1530-1536.
39. Inoue M, Sawabata N, Takeda S, et al. Results of surgical intervention for p-stage ⅢA (N2) non-small cell lung cancer: acceptable prognosis predicted by complete resection in patients with single N2 disease with primary tumor in the upper lobe. J Thorac Cardiovasc Surg, 2004, 127(4): 1100-1106.
40. Matsuguma H, Nakahara R, Ishikawa Y, et al. Postoperative radiotherapy for patients with completely resected pathological stage ⅢA-N2 non-small cell lung cancer: Focusing on an effect of the number of mediastinal lymph node stations involved. Interact Cardiovasc Thorac Surg, 2008, 7(4): 573-577.
41. Bueno R, Richards WG, Swanson SJ, et al. Nodal stage after induction therapy for stage ⅢA lung cancer determines patient survival. Ann Thorac Surg, 2000, 70(6): 1826-1831.
42. de Cabanyes Candela S, Detterbeck FC. A systematic review of restaging after induction therapy for stage Ⅲa lung cancer: Prediction of pathologic stage. J Thorac Oncol, 2010, 5(3): 389-398.
43. Cerfolio RJ, Bryant AS, Ojha B. Restaging patients with N2 (stage Ⅲa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: A prospective study. J Thorac Cardiovasc Surg, 2006, 131(6): 1229-1235.
44. De Waele M, Hendriks J, Lauwers P, et al. Restaging the mediastinum in non-small cell lung cancer after induction therapy: Non-invasive versus invasive procedures. Acta Chir Belg, May-Jun 2011, 111(3): 161-164.
45. Annema JT, Veseliç M, Versteegh MI, et al. Mediastinal restaging: EUS-FNA offers a new perspective. Lung Cancer, 2003, 42(3): 311-318.
46. De Waele M, Serra-Mitjans M, Hendriks J, et al. Accuracy and survival of repeat mediastinoscopy after induction therapy for non-small cell lung cancer in a combined series of 104 patients. Eur J Cardiothorac Surg, 2008, 33(5): 824-828.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of induction chemotherapy or chemoradiotherapy followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small cell lung cancer: A systematic review and meta-analysis

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