Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China.
PLoS One. 2018 Dec 31;13(12):e0210001. doi: 10.1371/journal.pone.0210001. eCollection 2018.
The role of surgery in treating small cell lung cancer (SCLC) remains controversial. This meta-analysis aims to determine whether surgical-based treatment improves survival in comparison to radiotherapy, chemotherapy, and chemoradiotherapy for stage I to III SCLC.
PubMed, PubMed Central, EMBASE, Web of Science, and Cochrane Library were searched for relevant articles. The main outcome were overall survival (OS), reported as hazard ratios (HRs), and 95% confidence intervals (CIs).
Two randomized control trials (RCTs) and 13 retrospective studies that included a total of 41,483 patients were eligible. Surgical resection significantly improved OS when compared to non-surgical treatment in retrospective studies (HR = 0.56, 95% CI: 0.49-0.64, P < 0.001), but not in the 2 "older" RCTs (HR = 0.77, 95% CI: 0.32-1.84, P = 0.55). In the subgroup analysis for retrospective studies, surgical resection was associated with superior OS in stage I (HR = 0.56, 95% CI: 0.49-0.64, P < 0.001), stage II (HR = 0.75, 95% CI: 0.57-0.99, P = 0.04), and stage III diseases (HR = 0.70, 95% CI: 0.56-0.88, P = 0.002). Sublobar resection resulted in worse OS than a lobectomy (HR = 0.64, 95% CI: 0.56-0.74, P < 0.001) for patients undergoing surgical resection.
Surgery-based multi-modality treatment appears to be associated with a favorable survival advantage in stage I and selected stage II to III SCLC. Lobectomy is likely to provide superior OS when compared to sublobar resection. Further prospective RCTs are needed to confirm these findings.
手术在治疗小细胞肺癌（SCLC）中的作用仍存在争议。本荟萃分析旨在确定与放疗、化疗和放化疗相比，基于手术的治疗是否能改善 I 期至 III 期 SCLC 的生存。
检索了 PubMed、PubMed Central、EMBASE、Web of Science 和 Cochrane Library 中的相关文章。主要结局是总生存期（OS），以风险比（HR）和 95%置信区间（CI）表示。
两项随机对照试验（RCT）和 13 项回顾性研究共纳入了 41483 名患者，符合条件。与非手术治疗相比，手术切除在回顾性研究中显著改善了 OS（HR=0.56，95%CI：0.49-0.64，P<0.001），但在 2 项“较旧”的 RCT 中没有（HR=0.77，95%CI：0.32-1.84，P=0.55）。在回顾性研究的亚组分析中，手术切除与 I 期（HR=0.56，95%CI：0.49-0.64，P<0.001）、II 期（HR=0.75，95%CI：0.57-0.99，P=0.04）和 III 期疾病（HR=0.70，95%CI：0.56-0.88，P=0.002）的 OS 改善相关。与肺叶切除术相比，亚肺叶切除术导致手术切除的患者 OS 更差（HR=0.64，95%CI：0.56-0.74，P<0.001）。
基于手术的多模式治疗似乎与 I 期和选定的 II 期至 III 期 SCLC 的生存获益相关。与亚肺叶切除术相比，肺叶切除术可能提供更好的 OS。需要进一步的前瞻性 RCT 来证实这些发现。
