IA期非小细胞肺癌肺段切除术与肺叶切除术的系统评价和荟萃分析

Systematic review and meta-analysis of segmentectomy . lobectomy for stage IA non-small cell lung cancer.

作者信息

Dai Zhangyi, Hu Jiawen, Shen Cheng, Mi Xingqi, Pu Qiang

机构信息

Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China.

Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.

出版信息

J Thorac Dis. 2023 Aug 31;15(8):4292-4305. doi: 10.21037/jtd-23-410. Epub 2023 Jul 24.

BACKGROUND

Whether segmentectomy is appropriate for stage IA non-small cell lung cancer (NSCLC), especially for stage IA NSCLC with a tumor size of 2-3 cm, remains controversial. Thus, we conducted this meta-analysis to compare segmentectomy and lobectomy for stage IA NSCLC with a tumor size of 2-3 cm and IA ≤2 cm NSCLC.

METHODS

A systematic screening of online databases (PubMed, Embase, Web of Science, and Cochrane Library) was conducted regarding the terms of perioperative outcomes, overall survival (OS), recurrence-free survival (RFS), and disease-free survival (DFS). The inverse-variance and Mantel-Haenszel approaches were used to pool effect sizes for survival outcomes and perioperative outcomes.

RESULTS

A total of 10 articles were included in the analysis. The perioperative morbidity [risk ratio (RR): 0.90, P=0.10], mortality (RR: 0.94, P=0.84), intraoperative blood loss [mean difference (MD): 3.07, P=0.86] and operative time (MD: 18.99, P=0.13) were comparable between the segmentectomy and lobectomy groups. The number of lymph nodes harvested was statistically less in segmentectomy than in lobectomy (MD: -5.71, P=0.02). In stage IA patients with a tumor size of 2-3 cm, lobectomy showed superior survival outcomes compared to segmentectomy, with a pooled hazard ratio (HR) of 1.39 (P=0.01) for OS and 1.38 (P=0.06) for RFS or DFS. In stage IA ≤2 cm, lobectomy and segmentectomy had comparable survival outcomes with pooled HRs of 1.18 (P=0.29) for OS and 1.18 (P=0.12) for RFS or DFS.

CONCLUSIONS

When a patient is in stage IA and the tumor size is less than 2 cm, segmentectomy should be performed. If the tumor size is between 2 and 3 cm, lobectomy is recommended.

背景

肺段切除术是否适用于ⅠA期非小细胞肺癌（NSCLC），尤其是肿瘤大小为2 - 3 cm的ⅠA期NSCLC，仍存在争议。因此，我们进行了这项荟萃分析，以比较肿瘤大小为2 - 3 cm的ⅠA期NSCLC以及肿瘤大小≤2 cm的ⅠA期NSCLC行肺段切除术和肺叶切除术的疗效。

方法

针对围手术期结局、总生存期（OS）、无复发生存期（RFS）和无病生存期（DFS）等检索词，对在线数据库（PubMed、Embase、Web of Science和Cochrane图书馆）进行系统筛选。采用逆方差法和Mantel-Haenszel法合并生存结局和围手术期结局的效应量。

结果

共纳入10篇文章进行分析。肺段切除术组和肺叶切除术组在围手术期发病率[风险比（RR）：0.90，P = 0.10]、死亡率（RR：0.94，P = 0.84）、术中失血量[均值差（MD）：3.07，P = 0.86]和手术时间（MD：18.99，P = 0.13）方面相当。肺段切除术组清扫的淋巴结数量在统计学上少于肺叶切除术组（MD：-5.71，P = 0.02）。在肿瘤大小为2 - 3 cm的ⅠA期患者中，肺叶切除术的生存结局优于肺段切除术，OS的合并风险比（HR）为1.39（P = 0.01），RFS或DFS的合并HR为1.38（P = 0.06）。在肿瘤大小≤2 cm的ⅠA期患者中，肺叶切除术和肺段切除术的生存结局相当，OS的合并HR为1.18（P = 0.29），RFS或DFS的合并HR为1.18（P = 0.12）。