Department of Radiology, Concord Repatriation General Hospital, Concord, NSW, 2137, Australia.
Concord Hospital Clinical Medical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
Eur Radiol. 2021 Jul;31(7):5421-5433. doi: 10.1007/s00330-020-07634-7. Epub 2021 Jan 15.
Multiple cohort studies have compared surgical resection with CT-guided percutaneous ablation for patients with stage 1 non-small cell lung cancer (NSCLC); however, the results have been heterogeneous. This systematic review and meta-analysis aims to compare surgery with ablation for stage 1 NSCLC.
A search of five databases was performed from inception to 5 July 2020. Studies were included if overall survival (OS), cancer-specific survival (CSS), and/or disease-free survival (DFS) were compared between patients treated with surgical resection versus ablation (radiofrequency ablation (RFA) or microwave ablation (MWA)) for stage 1 NSCLC. Pooled odds ratios (OR) were calculated.
A total of eight studies were included (total 792 patients: 460 resection and 332 ablation). There were no significant differences in 1- to 5-year OS or CSS between surgery versus ablation. There were significantly better 1- and 2-year DFS for surgery over ablation (OR 2.22, 95% CI 1.14-4.34; OR 2.60, 95% CI 1.21-5.57 respectively), but not 3- to 5-year DFS. Subgroup analysis demonstrated no significant OS difference between lobectomy and MWA, but there were significantly better 1- and 2-year OS with sublobar resection (wedge resection or segmentectomy) versus RFA (OR 2.85, 95% CI 1.33-6.10; OR 4.54, 95% CI 2.51-8.21, respectively). In the two studies which only included patients with stage 1A NSCLC, pooled outcomes demonstrated no significant differences in 1- to 3-year OS or DFS between surgery versus ablation.
Surgical resection of stage 1 NSCLC remains the optimal choice. However, for non-surgical patients with stage 1A, ablation offers promising DFS, CSS, and OS. Future prospective randomized controlled trials are warranted.
• Surgical resection of stage 1 NSCLC remains the optimal choice. • In patients with stage 1A NSCLC who are not surgical candidates, CT-guided microwave or radiofrequency ablation may be an alternative which offers promising disease-free survival and overall survival.
多项队列研究比较了手术切除与 CT 引导下经皮消融治疗Ⅰ期非小细胞肺癌（NSCLC）患者的效果；然而，结果存在异质性。本系统评价和荟萃分析旨在比较手术与消融治疗Ⅰ期 NSCLC 的效果。
从建库到 2020 年 7 月 5 日，对五个数据库进行了检索。如果治疗Ⅰ期 NSCLC 的患者接受手术切除与消融（射频消融（RFA）或微波消融（MWA））治疗后，总体生存率（OS）、癌症特异性生存率（CSS）和/或无病生存率（DFS）进行了比较，则纳入研究。计算汇总优势比（OR）。
共纳入 8 项研究（共 792 例患者：460 例手术切除，332 例消融）。手术与消融在 1 至 5 年 OS 或 CSS 方面无显著差异。手术组 1 年和 2 年 DFS 明显优于消融组（OR 2.22，95%CI 1.14-4.34；OR 2.60，95%CI 1.21-5.57），但 3 年至 5 年 DFS 无显著差异。亚组分析显示，肺叶切除术与 MWA 之间 OS 无显著差异，但亚肺叶切除术（楔形切除术或节段切除术）与 RFA 相比，1 年和 2 年 OS 明显更好（OR 2.85，95%CI 1.33-6.10；OR 4.54，95%CI 2.51-8.21）。在仅纳入ⅠA 期 NSCLC 患者的两项研究中，汇总结果显示手术与消融在 1 年至 3 年 OS 或 DFS 方面无显著差异。
手术切除Ⅰ期 NSCLC 仍然是最佳选择。然而，对于不能手术的ⅠA 期患者，CT 引导下微波或射频消融可能是一种有前途的治疗选择，能够提供良好的无病生存率和总生存率。未来需要前瞻性随机对照试验。
• 手术切除Ⅰ期 NSCLC 仍然是最佳选择。
• 对于不能手术的ⅠA 期 NSCLC 患者，CT 引导下微波或射频消融可能是一种有前途的治疗选择，可提供良好的无病生存率和总生存率。
