Dai Zhang-Yi, Shen Cheng, Wang Xinwei, Wang Fu-Qiang, Wang Yun
Department of Thoracic Surgery, West China hospital, SiChuan University, Chengdu, China.
Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Int J Surg. 2025 Mar 1;111(3):2675-2685. doi: 10.1097/JS9.0000000000002249.
While recent randomized controlled trials have demonstrated that sublobar resection (SLR) is non-inferior to lobectomy, the comparative efficacy of these procedures remains uncertain for early-stage non-small cell lung cancer (NSCLC; ≤3 cm) exhibiting invasive features postoperatively, such as visceral pleural invasion (VPI) or spread through air spaces (STAS).
To identify eligible studies, a comprehensive search of PubMed, Embase, MEDLINE, the Cochrane Library, and Web of Science was conducted through 25 July 2024. Studies were screened according to predefined criteria in accordance with PRISMA guidelines. The primary endpoints were 5-year overall survival (OS) and recurrence-free survival (RFS). Hazard ratios (HR) and 95% confidence intervals (CI) were used to perform a meta-analysis.
The final analysis included 14 retrospective studies and 1 randomized controlled trial, encompassing a total of 8054 patients with NSCLC (tumors ≤3 cm) exhibiting VPI or STAS. The meta-analysis revealed that SLR was associated with impaired 5-year OS (HR: 1.25; 95% CI: 1.10-1.41) and slightly inferior RFS (HR: 1.25; 95% CI: 0.99-1.58) compared to lobectomy for pT2a (VPI) NSCLC patients with tumor ≤3 cm. Similarly, SLR was associated with significantly worse 5-year OS (HR: 2.58; 95% CI: 1.92-3.45) and 5-year RFS (HR: 2.42; 95% CI: 1.69-3.46) compared to lobectomy for stage IA NSCLC patients with STAS. Subgroup analysis revealed that statistically significant differences in 5-year OS (HR: 1.13; 95% CI: 0.92-1.38) and 5-year RFS (HR: 0.87; 95% CI: 0.56-1.36) were not observed between the SLR and lobectomy groups for pT2a (VPI) NSCLC patients with tumor ≤2 cm. Additionally, no statistically significant survival difference was observed between the segmentectomy and lobectomy groups for NSCLC patients (≤3 cm) with VPI (5-year OS: HR: 1.16; 95% CI: 0.89-1.52; 5-year RFS: HR: 1.07; 95% CI: 0.88-1.30) or STAS (5-year OS: HR: 3.88; 95% CI: 0.82-18.31; 5-year RFS: HR: 1.64; 95% CI: 0.70-3.80).
For early-stage (≤3 cm) NSCLC with VPI or STAS, SLR was associated with worse survival outcomes compared to lobectomy. However, segmentectomy achieved survival outcomes comparable to those of lobectomy. For pT2a (VPI) NSCLC patients with tumor ≤2 cm, the differences in survival outcomes between SLR and lobectomy were not statistically significant.
虽然近期的随机对照试验表明，亚肺叶切除术（SLR）并不逊色于肺叶切除术，但对于术后具有侵袭性特征（如脏层胸膜侵犯（VPI）或气腔播散（STAS））的早期非小细胞肺癌（NSCLC；≤3 cm），这些手术的比较疗效仍不确定。
为了确定符合条件的研究，截至2024年7月25日，对PubMed、Embase、MEDLINE、Cochrane图书馆和Web of Science进行了全面检索。根据PRISMA指南中的预定义标准对研究进行筛选。主要终点是5年总生存期（OS）和无复发生存期（RFS）。采用风险比（HR）和95%置信区间（CI）进行荟萃分析。
最终分析纳入了14项回顾性研究和1项随机对照试验，共纳入8054例具有VPI或STAS的NSCLC（肿瘤≤3 cm）患者。荟萃分析显示，对于肿瘤≤3 cm的pT2a（VPI）NSCLC患者，与肺叶切除术相比，SLR与5年OS受损（HR：1.25；95%CI：1.10-1.41）和稍差的RFS（HR：1.25；95%CI：0.99-1.58）相关。同样，对于具有STAS的IA期NSCLC患者，与肺叶切除术相比，SLR与显著更差的5年OS（HR：2.58；95%CI：1.92-3.45）和5年RFS（HR：2.42；95%CI：1.69-3.46）相关。亚组分析显示，对于肿瘤≤2 cm的pT2a（VPI）NSCLC患者，SLR组和肺叶切除术组之间在5年OS（HR：1.13；95%CI：0.92-1.38）和5年RFS（HR：0.87；95%CI：0.56-1.36）方面未观察到统计学显著差异。此外，对于具有VPI（5年OS：HR：1.16；95%CI：0.89-1.52；5年RFS：HR：1.07；95%CI：0.88-1.30）或STAS（5年OS：HR：3.88；95%CI：0.82-18.31；5年RFS：HR：1.64；95%CI：0.70-3.80）的NSCLC（≤3 cm）患者，肺段切除术组和肺叶切除术组之间未观察到统计学显著的生存差异。
对于具有VPI或STAS的早期（≤3 cm）NSCLC，与肺叶切除术相比，SLR与更差的生存结果相关。然而，肺段切除术的生存结果与肺叶切除术相当。对于肿瘤≤2 cm的pT2a（VPI）NSCLC患者，SLR和肺叶切除术之间的生存结果差异无统计学意义。
