IA期非小细胞肺癌的分段切除术与肺叶切除术：围手术期和生存结果的系统回顾和荟萃分析。

IF 4.5 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2024-10-21 DOI:10.1016/j.lungcan.2024.107990

Luca Bertolaccini , Antonino Carmelo Tralongo , Marzia Del Re , Francesco Facchinetti , Roberto Ferrara , Tindara Franchina , Paolo Graziano , Umberto Malapelle , Jessica Menis , Antonio Passaro , Sara Pilotto , Sara Ramella , Giulio Rossi , Rocco Trisolini , Michela Cinquini , Francesco Passiglia , Silvia Novello

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引用次数: 0

摘要

虽然最近的随机对照试验（RCT）表明，分段切除术的总生存期（OS）结果优于肺叶切除术，但这些手术方法在治疗早期非小细胞肺癌（NSCLC）方面的可比性仍存在疑问。本系统综述和荟萃分析旨在综合现有证据，比较分段切除术或肺叶切除术治疗IA期NSCLC的生存效果。共分析了 40 项研究（38 项观察性研究，2 项 RCT 研究），涉及 103,926 名患者。主要结果包括总生存期（OS）、无病生存期（DFS）、局部复发、摘除淋巴结、术后发病率和住院时间。偏倚风险采用既定工具进行评估，证据确定性采用 GRADE 进行评估。非研究性试验显示，OS HR 为 1.10（95 % CI：0.94-1.30，p = 0.24），确定性较低，而研究性试验的 HR 为 0.82（95 % CI：0.66-1.02，p = 0.7），确定性中等。局部复发在确定性较低的非研究性试验中表现为 OR 1.40（95 % CI：0.94-2.08，p = 0.09），在确定性较低的研究性试验中表现为 RR 1.61（95 % CI：1.12-2.31，p = 0.01）。非研究性试验的 DFS HR 为 1.13（95 % CI：0.95-1.34，p = 0.18），确定性较低；而研究性试验的 HR 为 1.00（95 % CI：0.85-1.18，p = 0.97），确定性中等。肺叶切除术可收获更多淋巴结。术后发病率和住院时间差异不大。虽然 OS、DFS 和术后结果差异的确切证据尚不确定，但注意到肺叶切除术后局部复发可能会增加。有必要进一步开展设计良好的研究，以增强证据并为 I 期肺癌手术的临床实践提供参考。

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Segmentectomy vs. Lobectomy in stage IA non-small cell lung cancer: A systematic review and meta-analysis of perioperative and survival outcomes

While recent randomized controlled trials (RCT) have suggested superior overall survival (OS) outcomes with segmentectomy over lobectomy, questions remain regarding the comparability of these surgical procedures for treating early-stage non-small cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to synthetize existing evidence and to compare the survival outcomes observed for stage IA NSCLC following segmentectomy or lobectomy.

40 studies (38 observational, 2 RCTs) encompassing 103,926 patients were analyzed. Primary outcomes included overall survival (OS), disease-free survival (DFS), local recurrences, harvested lymph nodes, postoperative morbidity, and length of hospital stay. Risk of bias was assessed using established tools, and evidence certainty was evaluated using GRADE.

Non-RCTs showed an OS HR of 1.10 (95 % CI: 0.94–1.30, p = 0.24) with low certainty, contrasting with RCTs’ HR of 0.82 (95 % CI: 0.66–1.02, p = 0.7) with moderate certainty. Local recurrences exhibited OR 1.40 (95 % CI: 0.94–2.08, p = 0.09) in non-RCTs with low certainty, and RR 1.61 (95 % CI: 1.12–2.31, p = 0.01) in RCTs with low certainty. Non-RCTs showed DFS HR 1.13 (95 % CI: 0.95–1.34, p = 0.18) with low certainty, while RCTs yielded HR 1.00 (95 % CI: 0.85–1.18, p = 0.97) with moderate certainty. Lobectomy resulted in more harvested lymph nodes. Postoperative morbidity and length of hospital stay did not differ significantly.

While definitive evidence for OS, DFS, and postoperative outcomes differences was inconclusive, a potential increase in local recurrences following lobectomy was noted. Further well-designed studies are warranted to enhance evidence and inform clinical practice in stage I lung cancer surgery.

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来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.