IA3期（T1cN0M0）非小细胞肺癌肺叶切除术与肺段切除术的Meta分析和系统评价

Lobectomy versus segmentectomy for stage IA3 (T1cN0M0) non-small cell lung cancer: a meta-analysis and systematic review.

作者信息

Zhang Wanfei, Chen Shaogeng, Lin Xianzuan, Chen Hongbo, He Rongqi

机构信息

Department of Thoracic Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China.

出版信息

Front Oncol. 2023 Oct 2;13:1270030. doi: 10.3389/fonc.2023.1270030. eCollection 2023.

DOI:10.3389/fonc.2023.1270030

PMID:37849809

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10578965/

Abstract

BACKGROUND

Segmentectomy has been proven to have better survival and perioperative efficacy than lobectomy for non-small cell lung cancer (NSCLC) up to 2 cm. Whether this result is applicable to stage T1cN0M0 NSCLC (2.1 to 3 cm) remains controversial.

METHODS

We conducted a comprehensive search across seven databases to identify relevant studies comparing lobectomy and segmentectomy procedures. Our primary focus was on survival indicators (overall survival [OS] and disease-free survival [DFS]), while for secondary outcomes, operative outcomes, hospitalization outcomes, recurrences, and complications were considered.

RESULTS

After screening, the final analysis included 10 studies (involving 22113 patients in the lobectomy group and 1627 patients in the segmentectomy group). The lobectomy procedure achieved better OS (hazard ratio [HR]: 1.19 [1.07~~1.33]) and DFS (HR: 1.37 [1.10~~1.71]), which were proven in all subgroups. The OS rate at 2-5 years and DFS rate at 4-5 years were higher in the lobectomy group. The advantages of OS and DFS in the lobectomy group increased over the survival time. More lymph node dissections, intraoperative blood loss and total complications were found in the lobectomy group. Similar hospital stays, 90-day mortality and conversion thoracotomy were found between the two groups.

CONCLUSION

Lobectomy appeared to be the better choice for patients with stage T1cN0M0 NSCLC with better survival (OS and DFS). However, the complications needed to be taken seriously.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identification CRD42023445013.

摘要

背景

对于直径达2厘米的非小细胞肺癌（NSCLC），肺段切除术已被证明比肺叶切除术具有更好的生存率和围手术期疗效。这一结果是否适用于T1cN0M0期NSCLC（2.1至3厘米）仍存在争议。

方法

我们对七个数据库进行了全面检索，以确定比较肺叶切除术和肺段切除术的相关研究。我们主要关注生存指标（总生存期[OS]和无病生存期[DFS]），而次要结果则考虑手术结果、住院结果、复发和并发症。

结果

筛选后，最终分析纳入10项研究（肺叶切除术组22113例患者，肺段切除术组1627例患者）。肺叶切除术在OS（风险比[HR]：1.19[1.07~~1.33]）和DFS（HR：1.37[1.10~~1.71]）方面表现更好，在所有亚组中均得到证实。肺叶切除术组2至5年的OS率和4至5年的DFS率更高。肺叶切除术组在OS和DFS方面的优势随生存时间增加。肺叶切除术组的淋巴结清扫更多、术中失血量和总并发症更多。两组的住院时间、90天死亡率和中转开胸情况相似。