First-Line Integration of Local Ablative Therapy With EGFR Tyrosine Kinase Inhibitors in Advanced EGFR+ NSCLC: A Systematic Review and Meta-Analysis.

Integrating local ablative therapy (LAT) with first-line EGFR tyrosine kinase inhibitor (TKI) monotherapy represents an alternative approach to enhance disease control while preserving long-term tolerability.

将局部消融治疗（LAT）与一线EGFR酪氨酸激酶抑制剂（TKI）单药治疗相结合，代表了一种增强疾病控制同时保持长期耐受性的替代方法。

Methods

MEDLINE, Embase, and Elicit were searched to December 2025.

检索了MEDLINE、Embase和Elicit数据库，截止到2025年12月。

The protocol was registered in PROSPERO (CRD420251244650).

该方案已在PROSPERO注册（CRD420251244650）。

Randomized and nonrandomized comparative studies evaluating EGFR TKI with or without LAT integrated into first-line treatment, either upfront or as consolidative therapy, were included in quantitative meta-analyses.

评估EGFR酪氨酸激酶抑制剂（TKI）与或不与LAT整合到一线治疗中的随机和非随机比较研究，无论是作为初期治疗还是作为巩固治疗，均被纳入定量荟萃分析。

Single-arm and noncomparative studies were analyzed descriptively.

单臂和非比较性研究被描述性分析。

Hazard ratios (HRs) were pooled using random-effects models.

使用随机效应模型汇总了风险比（HRs）

Prespecified subgroup analyses explored disease burden, LAT timing, study design (prospective versus retrospective), LAT site, and TKI generation.

预设的亚组分析探讨了疾病负担、LAT时机、研究设计（前瞻性与回顾性）、LAT部位和TKI代数。

Results

A total of 31 studies met the inclusion criteria, including 24 comparative studies (six randomized, two prospective nonrandomized, and 16 retrospective).

共有31项研究符合纳入标准，包括24项比较研究（六项随机研究，两项前瞻性非随机研究和十六项回顾性研究）。

LAT integration significantly improved progression-free survival(HR = 0.45, 95% confidence interval: 0.37-0.55) and overall survival(HR = 0.52, 95% confidence interval: 0.40-0.67) versus EGFR TKI alone.

LAT整合显著改善了无进展生存期（HR=0.45，95%置信区间：0.37-0.55）和总生存期（HR=0.52，95%置信区间：0.40-0.67），与单独使用EGFR酪氨酸激酶抑制剂相比。

Benefits were consistent across oligometastatic and unselected populations, upfront and consolidative strategies, LAT sites (primary tumor with or without metastatic sites), TKI generations, and prospective and retrospective studies.

益处在全球转移和未选择的人群、早期和巩固策略、LAT部位（原发肿瘤有或没有转移部位）、TKI代以及前瞻性与回顾性研究中保持一致。

Radiotherapy-related toxicities, particularly pneumonitis, were more frequent with LAT, but grade more than or equal to 3 events were uncommon and no unexpected safety signals emerged.

与LAT相关的放射治疗毒性，特别是肺炎，更为频繁，但大于或等于3级的事件不常见，且未出现任何意外的安全信号。

Conclusions

Across a heterogeneous evidence base, integrating LAT into first-line EGFR TKI therapy is associated with improved progression-free survivaland overall survivalwith acceptable toxicity.

在异质性的证据基础上，将LAT整合到一线EGFR TKI治疗中与改善无进展生存期和总生存期相关，并且毒性可接受。

These findings support further prospective investigation to better define patient selection, optimal timing, and integration with contemporary systemic combination strategies.

这些发现支持进一步的前瞻性研究，以更好地定义患者选择、最佳时机以及与当代系统性联合治疗策略的整合。