Li Jialong, Wang Yan, Li Jue, Cao Shangqi, Che Guowei
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Clin Lung Cancer. 2022 May;23(3):208-213. doi: 10.1016/j.cllc.2021.10.004. Epub 2021 Oct 23.
Surgery is the preferred treatment for early-stage non-small cell lung cancer (NSCLC). Numerous studies have shown that spread through air spaces (STAS) can predict the survival of patients with stage I NSCLC. However, for stage I NSCLC, it is not known whether sublobar resection or lobectomy should be performed if STAS is present. In the present study, we compared the survival outcomes of patients with STAS who underwent lobectomy versus those who underwent sublobar resection. A search was performed on the PubMed, Cochrane Library and EMBASE on March 6, 2021 to identify relevant studies. Predetermined criteria were utilized to screen studies. A meta-analysis was performed using hazard ratio (HR). In total, 13 studies involving 5947 patients were included in the meta-analysis. It was found that STAS was significantly correlated with worse RFS (HR = 2.58, 95% CI: 2.16-3.07) and OS (HR = 2.41, 95% CI: 1.97-2.95) in patients with stage I NSCLC. Lobectomy resulted in a longer RFS (HR = 2.59, 95% CI: 1.99-3.37) and OS (HR = 2.78, 95% CI: 1.92-4.02) than sublobar resection in stage I NSCLC patients with STAS. STAS is an independent prognostic factor in NSCLC. Lobectomy may be more effective for stage I NSCLC patients who underwent sublobar resection previously if STAS is present.
手术是早期非小细胞肺癌（NSCLC）的首选治疗方法。大量研究表明，气腔播散（STAS）可预测Ⅰ期NSCLC患者的生存情况。然而，对于Ⅰ期NSCLC，如果存在STAS，尚不清楚应进行亚肺叶切除还是肺叶切除。在本研究中，我们比较了接受肺叶切除的STAS患者与接受亚肺叶切除的STAS患者的生存结局。2021年3月6日在PubMed、Cochrane图书馆和EMBASE上进行了检索以识别相关研究。采用预定标准筛选研究。使用风险比（HR）进行荟萃分析。荟萃分析共纳入13项研究，涉及5947例患者。结果发现，在Ⅰ期NSCLC患者中，STAS与更差的无复发生存期（RFS）（HR = 2.58，95%CI：2.16 - 3.07）和总生存期（OS）（HR = 2.41，95%CI：1.97 - 2.95）显著相关。在伴有STAS的Ⅰ期NSCLC患者中，肺叶切除比亚肺叶切除导致更长的RFS（HR = 2.59，95%CI：1.99 - 3.37）和OS（HR = 2.78，95%CI：1.92 - 4.02）。STAS是NSCLC的独立预后因素。如果存在STAS，对于先前接受过亚肺叶切除的Ⅰ期NSCLC患者，肺叶切除可能更有效。
