Turner Simon R, Butts Charles A, Debenham Brock J, Stewart Kenneth C
Division of Thoracic Surgery, University of Alberta, Edmonton, AB, Canada.
Division of Medical Oncology, University of Alberta, Edmonton, AB, Canada.
Interact Cardiovasc Thorac Surg. 2019 Jan 1;28(1):41-44. doi: 10.1093/icvts/ivy223.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: Is lobectomy superior to sublobar resection (SLR) for early-stage (cT1/2N0) small-cell lung cancer (SCLC) discovered intraoperatively? Altogether, more than 360 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Surgical treatment was shown to be superior to non-surgical treatment for early-stage SCLC in 8 papers. Seven papers showed that among patients treated surgically, lobectomy is associated with improved survival compared to SLR. One paper demonstrated both improved survival and improved freedom from local recurrence. However, 1 paper showed no difference when lobectomy was compared to anatomical segmentectomy. Three papers demonstrated significant rates of upstaging in surgical patients. Although both lobectomy and SLR are associated with improved survival compared with non-surgical treatment in early-stage SCLC, lobectomy is superior. Lobectomy was associated with improved median and overall survival, better upstaging and decreased local recurrence compared to SLR, although there is potential for selection bias and stage migration. Lobectomy should be considered the optimal approach for patients with early-stage SCLC.
一篇胸外科最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是：对于术中发现的早期（cT1/2N0）小细胞肺癌（SCLC），肺叶切除术是否优于亚肺叶切除术（SLR）？通过报告的检索共找到360多篇论文，其中10篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期和国家、所研究的患者群体、研究类型、相关结局和结果均列表展示。8篇论文表明手术治疗对早期SCLC优于非手术治疗。7篇论文显示，在接受手术治疗的患者中，与SLR相比，肺叶切除术与生存率提高相关。1篇论文表明生存率提高且局部复发自由度改善。然而，1篇论文显示肺叶切除术与解剖性肺段切除术相比无差异。3篇论文表明手术患者中有显著的分期升级率。虽然在早期SCLC中，与非手术治疗相比，肺叶切除术和SLR均与生存率提高相关，但肺叶切除术更具优势。与SLR相比，肺叶切除术与中位生存期和总生存期改善、更好的分期升级以及局部复发减少相关，尽管存在选择偏倚和分期迁移的可能性。肺叶切除术应被视为早期SCLC患者的最佳治疗方法。
