e20037 Background: For early-stage non-small cell lung cancer (NSCLC), surgery is preferred for operable patients, while stereotactic body radiotherapy (SBRT) is standard for inoperable cases. This meta-analysis compared survival and disease control outcomes using propensity-matched data to minimize confounding. Methods: A systematic review and meta-analysis was conducted per PRISMA guidelines, including propensity-matched studies comparing SBRT and surgery for stage I-II NSCLC through June 2025. Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), local control (LC), distant control (DC), and recurrence. Results: 34 propensity-matched studies comprising 14,224 patients were included. Surgery was associated with improved overall survival (pooled HR = 0.70, 95% CI 0.54–0.91) and cancer-specific survival (HR = 0.72, 95% CI 0.52–0.99). Fixed-time analyses reinforced these findings, showing significantly higher 1-year (OR = 1.33) and 3-year (OR = 1.89) survival with surgery, with the benefit increasing over longer follow-up (P for subgroup difference = 0.039). Surgery also demonstrated superior disease-free survival (OR = 1.99, 95% CI 1.49–2.64) and local control (HR = 0.25, 95% CI 0.09–0.64; OR = 2.57, 95% CI 1.66–3.99). In contrast, distant control did not differ significantly between treatments (OR = 1.30, 95% CI 0.99–1.72). Local recurrence was more common after SBRT (OR = 2.96, 95% CI 1.56–5.61). Meta-regression showed no significant temporal trend in outcomes. Residual demographic differences persisted, with SBRT patients being older on average (73.3 vs. 70.3 years). Conclusions: For operable early-stage NSCLC, surgical resection provides superior OS, CSS, DFS, and LC compared to SBRT, with the survival benefit becoming more pronounced over longer follow-up. SBRT remains a vital, effective option for inoperable patients, offering excellent short-term control with lower procedural risk. The findings underscore the importance of surgical staging and complete tumor removal for maximizing long-term outcomes in fit patients. Multidisciplinary, patient-centered decision-making, considering comorbidities, functional status, and diagnostic needs, is essential for optimal treatment selection. Summary of meta-aAnalysis results. Outcome Hazard Ratio (95% CI) Odds Ratio (95% CI) Favors Overall Survival 0.70 (0.54–0.91) 1.67 (1.43–1.96) Surgery Cancer-Specific Survival 0.72 (0.52–0.99) 1.99 (1.47–2.70) Surgery Disease-Free Survival - 1.99 (1.49–2.64) Surgery Local Control 0.25 (0.09–0.64) 2.57 (1.66–3.99) Surgery Distant Control 0.28 (0.11–0.73) 1.30 (0.99–1.72) Neutral Locoregional Control 0.45 (0.28–0.72) 0.64 (0.14–3.00) Surgery (HR only)
Alghzawi et al. (Thu,) studied this question.