Cao Christopher, Gupta Sunil, Chandrakumar David, Tian David H, Black Deborah, Yan Tristan D
1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Ann Cardiothorac Surg. 2014 Mar;3(2):134-41. doi: 10.3978/j.issn.2225-319X.2014.03.08.
Surgical resection is the preferred treatment modality for eligible candidates with non-small cell lung cancer (NSCLC). However, the selection of sublobar resection versus lobectomy for early-stage NSCLC remains controversial. Previous meta-analyses comparing these two procedures presented data without considering the significant differences in the patient selection processes in individual studies. The present study aimed to compare the overall survival (OS) and disease-free survival (DFS) outcomes of patients who underwent sublobar resections who were also eligible for lobectomy procedures with those who underwent lobectomy.
An electronic search was conducted using five online databases from their dates of inception to December 2013. Studies were selected according to predefined inclusion criteria and meta-analyzed using hazard ratio (HR) calculations.
Twelve studies met the selection criteria, including 1,078 patients who underwent sublobar resections and 1,667 patients who underwent lobectomies. From the available data, there was no significant differences in OS [HR 0.91; 95% confidence interval (CI) 0.64-1.29] or DFS (HR 0.82; 95% CI 0.60-1.12) between the two treatment arms. In addition, no significant OS difference was detected for patients who underwent segmentectomies compared to lobectomies (HR 1.04; 95% CI 0.66-1.63, P=0.86).
Using the available data in the current literature, patients who underwent sublobar resection for small, peripheral NSCLC after intentional selection rather than ineligibility for greater resections achieved similar long-term survival outcomes as those who underwent lobectomies. However, patients included for the present meta-analysis were a highly selected cohort and these results should be interpreted with caution. The importance of the patient selection process in individual studies must be acknowledged to avoid conflicting outcomes in future meta-analyses.
手术切除是符合条件的非小细胞肺癌（NSCLC）患者的首选治疗方式。然而，早期NSCLC患者选择肺段切除术还是肺叶切除术仍存在争议。以往比较这两种手术的荟萃分析所呈现的数据未考虑各研究中患者选择过程的显著差异。本研究旨在比较有资格接受肺叶切除术的患者接受肺段切除术后的总生存期（OS）和无病生存期（DFS）结果与接受肺叶切除术的患者的结果。
利用五个在线数据库从其创建日期至2013年12月进行电子检索。根据预先定义的纳入标准选择研究，并使用风险比（HR）计算进行荟萃分析。
12项研究符合选择标准，包括1078例行肺段切除术的患者和1667例行肺叶切除术的患者。根据现有数据，两组治疗组在OS（HR 0.91；95%置信区间[CI] 0.64 - 1.29）或DFS（HR 0.82；95% CI 0.60 - 1.12）方面无显著差异。此外，与肺叶切除术相比，行肺段切除术的患者未检测到显著的OS差异（HR 1.04；95% CI 0.66 - 1.63，P = 0.86）。
根据当前文献中的现有数据，经有意选择而非因不符合更大范围切除术条件而接受肺段切除术治疗小的周围型NSCLC患者，与接受肺叶切除术的患者取得了相似的长期生存结果。然而，纳入本荟萃分析的患者是经过高度选择的队列，这些结果应谨慎解释。必须认识到个体研究中患者选择过程的重要性，以避免未来荟萃分析出现相互矛盾的结果。
