肺段切除术对比肺楔形切除术治疗早期非小细胞肺癌的Meta分析

A meta-analysis of segmentectomies versus wedge resections for early stage non-small cell lung cancer

目的应用Meta分析的方法比较肺段切除与肺楔形切除治疗早期非小细胞肺癌的效果。方法检索Pub Med、Embase、Ovid、Cochrane、中国知网数据库、万方数据库这6个数据库,检索时间为每个数据库建库至2016年8月,收集有关肺段切除术和肺楔形切除术治疗早期非小细胞肺癌的随机临床研究和非随机研究。采用Rev Man5.3软件进行Meta分析。结果共纳入11篇文献进行研究,总患者数为1 830例。其中行肺段切术患者1 010例,行肺楔形切除术患者820例。Meta分析显示,肺段切除术手术时间(WMD 12.25,95%CI 8.18~16.32,P<0.000 01)、患者的住院时间(WMD 1.31,95%CI 0.79~1.84,P<0.000 01)长于肺楔形切除术,患者的术后并发症(OR 1.93,95%CI 1.39~2.68,P<0.0001)、术后肿瘤局部复发率(OR 0.23,95%CI 0.15~0.37,P<0.000 01)低于肺楔形切除术患者。肺段切除术淋巴结清扫站数(WMD 4.09,95%CI 2.97~5.22,P<0.000 01)、患者5年生存率(OR 2.95,95%CI 2.05~4.25,P<0.000 01)优于肺楔形切除术。而两者的肿瘤远处转移率(OR0.73,95%CI 0.38~1.39,P=0.34)差异无统计学意义。结论肺段切除术相对于肺楔形切除术能更好的提高患者生存质量,但患者手术时间和住院时间更长。

Objective Using meta-analysis to compare surgical efficacy of segmentectomies or wedge resections on early stage non-small cell lung cancer. Methods We searched Pub Med,EMbase,OVID,Cochrane Library,CNKI and WFPD to collect randomized controlled trials( RCTs) and non-randomized clinical trials( nRCTs) of segmentectomies versus wedge resections for early stage non-small cell lung cancer. Each database was searched from establishment to August 2016. Rev Man5. 3 meta-analysis software was used. Results We finally identified 1 RCTs and 10 nRCTs research involving 1 830 patients. There were 1 010 patients in the segmentectomies group and 820 patients in the wedge resections group. The meta-analysis showed that compared with wedge resections,patients receiving segmentectomy had a longer operation time( WMD 12. 25,95% CI 8. 18-16. 32,P < 0. 000 01) and hospital stay( WMD 1. 31,95% CI0. 79-1. 84,P < 0. 000 01) and lower local recurrence( OR 0. 23,95% CI 0. 15-0. 37,P < 0. 000 01) and lower complications( OR1. 93,95% CI 1. 39-2. 68,P < 0. 0001). Patients receiving segmentectomy also showed superiority for 5-year survival( OR 2. 95,95%CI 2. 05-4. 25,P < 0. 000 01) and lymph node dissection( HR 4. 09,95% CI 2. 97-5. 22,P < 0. 000 01). While there was no statistical difference in the cancer distant metastasis( OR 0. 73,95% CI 0. 38-1. 39,P = 0. 34). Conclusion Compared with wedge resections,patients receiving segmentectomy has a better survival quality,however,with a longer operation time and hospital stay.