目的:手术切除仍然是早期非小细胞肺癌(NSCLC)的主要治疗方法,肺叶切除术被认为是标准方法。然而,最近的证据表明,对于部分患者,肺叶下切除术可能是另一种选择。
方法:按照PRISMA指南进行系统评价和荟萃分析。纳入了比较NSCLC患者肺叶切除术和肺叶下切除术的随机对照试验(RCT)和倾向评分匹配(PSM)队列研究。主要结果是总生存期(OS),次要结局包括无病生存期(DFS),30天死亡率,和癌症复发率。从Kaplan-Meier曲线重建个体患者数据(IPD),并进行了一阶段和两阶段荟萃分析.
结果:共有18项研究涉及6,075例NSCLC患者(3,119例接受肺叶切除术,包括2,956次接受叶下切除术)。与肺叶下切除术相比,肺叶切除术具有明显更好的OS(风险比[HR]:0.78,95%置信区间[CI]:0.68-0.89,p<0.001)。然而,当肺叶下切除术进一步分为节段切除术和楔形切除术时,肺叶切除术和肺段切除术的OS无显著差异(HR:0.92,95CI:0.75-1.14,p=0.464),而叶切除术与楔形切除术相比OS较好(HR:0.52,95CI:0.41-0.67,p<0.001).肺叶切除术和肺叶下切除术的DFS结果相似(HR:0.98,95CI:0.84-1.14,p=0.778)。
结论:在NSCLC患者中,与肺叶下切除术相比,肺叶切除术具有更好的总生存率。然而,当亚叶切除术被细分时,肺段切除术显示与肺叶切除术相当的结果,而楔形切除术较差。这些发现支持考虑将节段切除术作为IA期NSCLC患者的手术选择。
OBJECTIVE: Surgical resection remains the primary treatment for early-stage non-small cell lung cancer (NSCLC), with lobectomy considered the standard approach. However, recent evidence suggests that sublobar resection may be an alternative option for select patients.
METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) and propensity-score matched (PSM) cohort studies comparing lobectomy and sublobar resection in NSCLC patients were included. The primary outcome was overall survival (OS), and secondary outcomes included disease-free survival (DFS), 30-day mortality, and cancer recurrence rates. Individual patient data (IPD) were reconstructed from Kaplan-Meier curves, and one-stage and two-stage meta-analyses were performed.
RESULTS: A total of 18 studies involving 6,075 NSCLC patients (3,119 undergoing lobectomy, 2,956 undergoing sublobar resection) were included. Lobectomy was associated with significantly better OS compared to sublobar resection (hazard ratio [HR]: 0.78, 95 % confidence interval [CI]: 0.68-0.89, p < 0.001). However, when sublobar resection was further divided into segmentectomy and wedge resection, no significant difference in OS was observed between lobectomy and segmentectomy (HR:0.92, 95 %CI: 0.75-1.14, p = 0.464) whereas lobar resection was associated with better OS compared to wedge resection (HR:0.52, 95 %CI: 0.41-0.67, p < 0.001). DFS outcomes were similar between lobectomy and sublobar resection (HR:0.98, 95 %CI: 0.84-1.14, p = 0.778).
CONCLUSIONS: Lobectomy is associated with better overall survival compared to sublobar resection in NSCLC patients. However, when sublobar resection is subdivided, segmentectomy shows comparable outcomes to lobectomy, while wedge resection is inferior. These findings support the consideration of segmentectomy as the surgical option of choice for Stage IA NSCLC patients.