Department of Cardiothoracic Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany.
Department of Thoracic Surgery, Regiomed-Klinikum Coburg GmbH, Coburg, Germany.
Lung. 2022 Aug;200(4):505-512. doi: 10.1007/s00408-022-00549-8. Epub 2022 Jun 30.
The recommended treatment for small-cell lung cancer (SCLC) currently is surgery in stage I disease. We wondered about stage II SCLC and present a meta-analysis on mean-survival of patients that underwent surgery for stage I and II compared to controls.
A systematic literature search was performed on December 01st 2021 in Medline, Embase and Cochrane Library. We considered studies published on the effect of surgery in SCLC since 2004 and assessed them using ROBINS-I. We preformed I-tests, Q-statistics, DerSimonian-Laird tests and Egger-regression. The meta-analysis was conducted according to PRISMA.
Out of 6826 records, seven studies with a total of 11,241 patients ('surgery group': 3911 patients; 'non-surgery group': 7330; treatment period: 1984-2015) were included. Heterogeneity between the studies was revealed in absence of any publication bias. Patient characteristics did not differ between the groups (p-value > 0.05). The mean-survival in an analysis of patients in stage I was 36.7 ± 10.8 months for the 'surgery group' and 20.3 ± 5.7 months for the 'non-surgery group' (p-value = 0.0084). A combined analysis of patients in stage I and II revealed a mean-survival of 32.0 ± 16.7 months for the 'surgery group' and 19.1 ± 6.1 months for the 'non-surgery group' (p-value = 0.0391). In a separate analysis of stage II, we were able to demonstrate a significant survival benefit after surgery (21.4 ± 3.6 versus 16.2 ± 3.9 months; p-value = 0.0493).
Our meta-analysis shows a significant survival benefit after surgery not only in the recommended stage I but also in stage II SCLC. Our data suggests that both stages should be considered for surgery of early SCLC.
小细胞肺癌（SCLC）的推荐治疗方法是 I 期疾病的手术。我们对 II 期 SCLC 感兴趣，并对接受 I 期和 II 期手术与对照组相比的患者平均生存进行了荟萃分析。
我们于 2021 年 12 月 1 日在 Medline、Embase 和 Cochrane Library 上进行了系统的文献检索。我们考虑了自 2004 年以来发表的关于 SCLC 手术效果的研究，并使用 ROBINS-I 进行了评估。我们进行了 I 检验、Q 统计、DerSimonian-Laird 检验和 Egger 回归。荟萃分析根据 PRISMA 进行。
在 6826 条记录中，有 7 项研究共纳入 11241 例患者（“手术组”：3911 例；“非手术组”：7330 例；治疗期：1984-2015 年）。研究之间存在异质性，但不存在任何发表偏倚。两组患者的特征无差异（p 值>0.05）。I 期患者的平均生存分析中，“手术组”为 36.7±10.8 个月，“非手术组”为 20.3±5.7 个月（p 值=0.0084）。I 期和 II 期患者的综合分析显示，“手术组”的平均生存为 32.0±16.7 个月，“非手术组”为 19.1±6.1 个月（p 值=0.0391）。在 II 期的单独分析中，我们能够证明手术后的生存获益显著（21.4±3.6 与 16.2±3.9 个月；p 值=0.0493）。
我们的荟萃分析表明，手术不仅在推荐的 I 期，而且在 II 期 SCLC 中都有显著的生存获益。我们的数据表明，早期 SCLC 应考虑两个阶段进行手术。
