本研究比较了可手术的非小细胞肺癌(NSCLC)患者的肺段切除术(ST)和楔形切除术(WR)的有效性和安全性差异。PubMed,EMBASE,搜索了Cochrane图书馆和WebofScience数据库,以查找从成立到2023年7月发表的论文。纳入标准基于人群,干预,比较器,结果和研究设计。在纳入的非随机研究中,选择ROBINS-I评估偏倚风险和证据质量。选择合适的效果大小,和亚组分析,异质性测试,应用敏感性分析和发表偏倚.共纳入18项回顾性研究,涉及19,381例可手术的NSCLC患者。5年总生存率[风险比(HR),0.19;95%置信区间(CI),0.04,0.34;P=0.014;I2=76.3%],肺癌特异性生存率(HR,0.3;95%CI,0.21,0.38;P<0.01;I2=13.8%)和转移率[比值比(OR),1.56;95%CI,1.03,2.38;P=0.037]接受WR治疗的可手术NSCLC患者比接受ST治疗的患者更差。术后并发症的发生率(OR,0.44;95%CI,WR组0.23,0.82)低于ST医治组。术后复发无差异(OR,2.15;95%CI,0.97,4.74;P=0.058)和死亡率(风险差异,0.04;95%CI,-0.03,0.11;P=0.287)组间。根据目前的证据,与接受WT治疗的患者相比,接受ST手术治疗的NSCLC患者具有更好的术后生存率,但并发症更多,而WR和ST对复发率和远处转移率的影响仍存在争议。
The present study compared the differences in effectiveness and safety between segmentectomy (ST) and wedge resection (WR) in patients with
operable non-small cell lung cancer (NSCLC). The PubMed, EMBASE, Cochrane Library and Web of Science databases were searched for papers published from inception until July 2023. The inclusion criteria were based on the population, intervention, comparator, outcomes and study designs. ROBINS-I was selected to assess the risk of bias and quality of evidence in the included non-randomised studies. Appropriate effect sizes were selected, and subgroup analyses, heterogeneity tests, sensitivity analyses and publication bias were applied. A total of 18 retrospective studies were included, involving 19,381 patients with
operable NSCLC. The 5-year overall survival rate [hazard ratio (HR), 0.19; 95% confidence interval (CI), 0.04, 0.34; P=0.014; I2=76.3%], lung cancer-specific survival rate (HR, 0.3; 95% CI, 0.21, 0.38; P<0.01; I2=13.8%) and metastasis rate [odds ratio (OR), 1.56; 95% CI, 1.03, 2.38; P=0.037] in patients with
operable NSCLC treated with WR were worse than those in patients treated with ST. The incidence of postoperative complications (OR, 0.44; 95% CI, 0.23, 0.82) in the WR group was lower than in the ST treatment group. There was no difference in postoperative recurrence (OR, 2.15; 95% CI, 0.97, 4.74; P=0.058) and mortality (risk difference, 0.04; 95% CI, -0.03, 0.11; P=0.287) between groups. Based on current evidence, patients with NSCLC treated with ST surgery have better postoperative survival but more complications than those patients treated with WT, while the effect of WR and ST on the recurrence rate and distant metastasis rate remains controversial.