I期非小细胞肺癌肺叶切除术与肺段切除术的比较：一项基于随机对照试验的荟萃分析。

Comparison of lobectomy and sublobar resection for stage I non-small cell lung cancer: a meta-analysis based on randomized controlled trials.

作者信息

Lu Genlin, Xiang Zhiyi, Zhou Yan, Dai Senjie, Tong Fei, Jiang Renya, Dai Min, Zhang Qiufeng, Zhang Difeng

机构信息

General Surgery Department, Longyou County People's Hospital, Quzhou, Zhejiang, China.

The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.

出版信息

Front Oncol. 2023 Oct 4;13:1261263. doi: 10.3389/fonc.2023.1261263. eCollection 2023.

BACKGROUND

This meta-analysis aimed to compare the prognostic between lobectomy and sublobar resection in patients with stage I non-small cell lung cancer (NSCLC).

METHODS

We conducted a detailed search in PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) comparing the prognosis of lobectomy and sublobar resection for stage I NSCLC, with the primary outcomes being overall survival (OS) and disease-free survival (DFS).

RESULTS

A total of 2222 patients were included in the 5 RCTs. The results showed no statistical difference in OS (HR=0.87, p=0.445) and DFS (HR=0.99, p=0.918) between patients who underwent lobectomy and sublobar resection during the total follow-up period. In terms of dichotomous variables, there were no statistical differences in OS (relative ratio [RR]=1.05, p=0.848) and DFS (RR=1.21, p=0.075) between the two groups during the total follow-up period, as well as 5-year OS (RR=0.96, p=0.409) and 5-year DFS (RR=0.95, p=0.270). In addition, subgroup analysis showed a better prognosis for non-adenocarcinoma patients with sublobar resection than lobectomy (HR=0.53, p=0.037), but also an increased cause of cancer death (not limited to lung cancer) (RR=1.56, p=0.004).

CONCLUSION

Our results showed that for stage I NSCLC, lobectomy is usually not a justified operation.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023407301, identifier CRD42023407301.

背景

本荟萃分析旨在比较Ⅰ期非小细胞肺癌（NSCLC）患者肺叶切除术和肺段切除术的预后。

方法

我们在PubMed、Embase、Web of Science和Cochrane图书馆中进行了详细检索，以查找比较Ⅰ期NSCLC肺叶切除术和肺段切除术预后的随机对照试验（RCT），主要结局为总生存期（OS）和无病生存期（DFS）。

结果

5项RCT共纳入2222例患者。结果显示，在整个随访期内，接受肺叶切除术和肺段切除术的患者在OS（风险比[HR]=0.87，p=0.445）和DFS（HR=0.99，p=0.918）方面无统计学差异。在二分变量方面，两组在整个随访期内的OS（相对比[RR]=1.05，p=0.848）和DFS（RR=1.21，p=0.075），以及5年OS（RR=0.96，p=0.409）和5年DFS（RR=0.95，p=0.270）方面均无统计学差异。此外，亚组分析显示，肺段切除术的非腺癌患者比肺叶切除术患者预后更好（HR=0.53，p=0.037），但癌症死亡原因（不限于肺癌）也有所增加（RR=1.56，p=0.004）。