Meldola Patrick F, Toth Otávio A S, Schnorrenberger Erick, Machado Pablo G, Chiarelli Gabriel F C, Kracik José L S, de Carvalho Caio C, Lôbo Matheus de M, Gross Jefferson L
Department of Medicine, Federal University of Santa Catarina, Engenheiro Agronômico Andrei Cristian Ferreira St., Florianópolis, Santa Catarina, 88040-900, Brazil.
Department of Cutaneous Oncology, A. C. Camargo Cancer Center, 211 Professor Antonio Prudente St., São Paulo, São Paulo, 01509-000, Brazil.
Surg Oncol. 2023 Dec;51:101995. doi: 10.1016/j.suronc.2023.101995. Epub 2023 Sep 22.
Surgical resection is the first-line treatment for early-stage lung cancer, with lobectomy being the standard choice since the 1960s. Nevertheless, recent studies have shown controversies about whether sublobar resection or lobectomy is the optimal surgical approach today. In this sense, this meta-analysis aims to compare these techniques. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing sublobar resection with lobectomy for stage IA non-small-cell lung cancer (NSCLC) and reporting any of the following outcomes: (1) Overall survival (OS); (2) disease-free survival (DFS); and (3) total disease recurrences. Sublobar resection encompassed wedge resection and segmentectomy techniques. A total of 1975 patients from four studies were included, of whom 978 (49.5%) underwent sublobar resection and 973 (49.3%) were male. All tumors were smaller than 2 cm. Follow-up ranged from 5 to 7.3 years. Mean age was 62.8 ± 37.0 years, and 1353 (68.5%) patients had a known smoking history. OS (HR 0.79; 95% CI 0.60-1.05; p = 0.11) and DFS (HR 1.02; 95% CI 0.86-1.22; p = 0.80) did not significantly differ between the sublobar resection and lobectomy groups. Similarly, no significant statistical difference was observed in total disease recurrences (RR 1.17; 95% CI 0.93-1.46; p = 0.17). Subgroup and isolated sublobar resection techniques analyses were not possible due to the lack of data. Sublobar resection and lobectomy have similar OS, DFS, and disease recurrence rates for stage IA NSCLC. These findings underline the need for new RCTs investigating these outcomes in specific patient subgroups and isolated sublobar resection techniques.
手术切除是早期肺癌的一线治疗方法，自20世纪60年代以来，肺叶切除术一直是标准选择。然而，最近的研究表明，对于如今肺段以下切除或肺叶切除哪种是最佳手术方式存在争议。从这个意义上说，这项荟萃分析旨在比较这些技术。通过检索PubMed、EMBASE和Cochrane数据库，寻找比较肺段以下切除与肺叶切除治疗IA期非小细胞肺癌（NSCLC）并报告以下任何一项结果的随机对照试验（RCT）：（1）总生存期（OS）；（2）无病生存期（DFS）；（3）疾病总复发率。肺段以下切除包括楔形切除和肺段切除术。共纳入四项研究中的1975例患者，其中978例（49.5%）接受了肺段以下切除，973例（49.3%）为男性。所有肿瘤均小于2cm。随访时间为5至7.3年。平均年龄为62.8±37.0岁，1353例（68.5%）患者有已知吸烟史。肺段以下切除组和肺叶切除组的OS（风险比[HR]0.79；95%置信区间[CI]0.60 - 1.05；p = 0.11）和DFS（HR 1.02；95% CI 0.86 - 1.22；p = 0.80）无显著差异。同样，在疾病总复发率方面也未观察到显著统计学差异（相对危险度[RR]1.17；95% CI 0.93 - 1.46；p = 0.17）。由于缺乏数据，无法进行亚组分析和单独的肺段以下切除技术分析。对于IA期NSCLC，肺段以下切除和肺叶切除的OS、DFS和疾病复发率相似。这些发现强调了需要开展新的RCT，以研究特定患者亚组和单独的肺段以下切除技术的这些结果。
