局限性肺切除对比肺叶切除治疗Ⅰ期非小细胞肺癌的Meta分析

A meta-analysis of limited resection versus lobectomy for stage I non-small cell lung cancer

目的系统评价局限性肺切除(包括肺段切除和楔形切除)与肺叶切除治疗I期非小细胞肺癌后总生存期和复发率。方法计算机检索Pubmed和EMBASE数据库,纳入比较局限性肺切除与肺叶切除治疗I期非小细胞肺癌后总生存期和复发的随机临床研究和非随机研究。结果最终纳入25篇文献,病例数8 968。对于I期非小细胞肺癌,局限性肺切除较肺叶切除术后总生存期差(HR=1.34,95%CI 1.15-1.56,P=0.0002),总体复发率(OR=1.41,95%CI 1.05-1.89,P=0.02)和局部复发率(OR=2.64,95%CI 1.77-3.93,P<0.00001)高;肺段切除与肺叶切除术后总生存期(HR=1.25,95%CI 0.98-1.58,P=0.07)和总体复发率(OR=1.20,95%CI 0.74-1.94,P=0.46)比较差异无统计学意义,但具有更高的局部复发率(OR=2.08,95%CI 1.13-3.83,P=0.02)。对于Ia期≤2 cm的非小细胞肺癌,局限性肺切除与肺叶切除的术后总生存期(HR=1.07,95%CI 0.93-1.23,P=0.34)、总体复发率(OR=0.55,95%CI 0.09-3.43,P=0.52)和局部复发率(OR=2.28,95%CI 0.34-15.41,P=0.40)差异无统计学意义。结论对于I期非小细胞肺癌,肺段切除有较好的总生存期,但面临局部复发率高的风险;对于Ia期≤2 cm的非小细胞肺癌,局限性肺切除与肺叶切除总生存期和复发率相当。

Objective To evaluate the survival and recurrence after limited resection and lobectomy in patients with stage I non-small cell lung cancer.Methods Eligible articles were identified by searching of the Pubmed and EMBASE database.Randomized clinical trials and non-randomized clinical trials were considered as eligible if the trials included patients with stage I NSCLC treated by limited resection or lobectomy.Results A total of 25 trials including 8 968 patients were studied.Compared with lobectomy,patients receiving limited resection had a statistically significant lower overall survival rate（HR= 1.34,95%CI 1.15-1.56,P=0.0002）,higher local recurrence（OR=2.64,95%CI 1.77-3.93,P0.00001） and higher overall recurrence（OR=1.41,95%CI 1.05-1.89,P=0.02）.Compared with lobectomy,patients receiving segmentectomy had a similar overall survival（HR=1.25,95%CI 0.98-1.58,P=0.07） and overall recurrence（OR=1.20,95%CI 0.74-1.94,P=0.46）,but the local recurrence was high（OR=2.08,95%CI 1.13-3.83,P=0.02）.For the comparison between limited resection and lobectomy,there were no significant difference on the overall survival（HR=1.07,95%CI 0.93-1.23,P=0.34）,overall recurrence（OR=0.55,95%CI 0.09-3.43,P=0.52） and local recurrence（OR=2.28,95%CI 0.34-15.41,P=0.40） for patients with stage Ia NSCLC with a tumor size of 2 cm or less.Conclusion Compared with lobectomy,patients receiving segmentectomy has a similar overall survival and a higher local recurrence.Limited resection produces similar overall survival,overall recurrence and local recurrence to lobectomy for patients with stage Ia NSCLC with a tumor size of 2 cm or less.