Department of Thoracic Surgery, West China Hospital.
Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
Int J Surg. 2024 Feb 1;110(2):1159-1171. doi: 10.1097/JS9.0000000000000896.
Currently, the impact of sublobar resection versus lobectomy on the prognosis of solid-dominant stage IA lung cancer is contradictory in different studies, which requires further exploration.
The authors analyzed 26 studies, including one randomized controlled trial and retrospective cohort studies. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using fixed-effects or random-effects models based on heterogeneity levels.
The analysis included 12 667 patients, with 3488 undergoing sublobar resections and 9179 receiving lobectomies. The overall analysis revealed no statistically significant difference in overall survival (OS) (HR=1.28, 95% CI: 0.98-1.69) between sublobar resection and lobectomy, but lobectomy was associated with better recurrence-free survival (RFS) (HR=1.39, 95% CI: 1.10-1.75). Subgroup analyses revealed that, for tumors with a diameter ≤2 cm, sublobar resection versus lobectomy showed no significant difference in OS but sublobar resection had lower RFS. For 2-3 cm tumors, both OS and RFS were significantly lower in the sublobar resection group. When consolidation-to-tumor ratio (CTR) ranged from 0.5 to <1, OS did not differ significantly, but RFS was significantly lower in sublobar resection. Lung cancers with CTR=1 showed significantly lower OS and RFS in the sublobar resection group. Segmentectomy provided similar OS and RFS compared to lobectomy, while wedge resection had a detrimental effect on patient prognosis. However, wedge resection may have provided comparable outcomes for patients aged 75 years or older.
Our findings suggest that segmentectomy and lobectomy yield similar oncological outcomes. However, compared to lobectomy, wedge resection is associated with a poorer prognosis. Nevertheless, for elderly patients, wedge resection is also a reasonable surgical option.
目前，亚肺叶切除术与肺叶切除术对实性为主型ⅠA 期肺癌预后的影响在不同研究中存在矛盾，需要进一步探讨。
作者分析了 26 项研究，包括一项随机对照试验和回顾性队列研究。根据异质性水平，使用固定效应或随机效应模型计算合并危险比（HR）和 95%置信区间（CI）。
分析纳入了 12667 例患者，其中 3488 例行亚肺叶切除术，9179 例行肺叶切除术。总体分析显示，亚肺叶切除术与肺叶切除术在总生存（OS）方面无统计学差异（HR=1.28，95%CI：0.98-1.69），但肺叶切除术与无复发生存（RFS）相关（HR=1.39，95%CI：1.10-1.75）。亚组分析显示，对于直径≤2cm 的肿瘤，亚肺叶切除术与肺叶切除术在 OS 方面无显著差异，但亚肺叶切除术的 RFS 较低。对于 2-3cm 的肿瘤，亚肺叶切除术组的 OS 和 RFS 均显著降低。当肿瘤实性成分占比（CTR）为 0.5 至<1 时，OS 无显著差异，但亚肺叶切除术的 RFS 较低。当 CTR=1 时，亚肺叶切除术组的 OS 和 RFS 显著降低。段切除术与肺叶切除术的 OS 和 RFS 相似，而楔形切除术对患者预后有不利影响。然而，楔形切除术可能为 75 岁或以上的患者提供了相似的治疗效果。
我们的研究结果表明，段切除术和肺叶切除术的肿瘤学结果相似。然而，与肺叶切除术相比，楔形切除术与较差的预后相关。然而，对于老年患者，楔形切除术也是一种合理的手术选择。
