Ⅰ期非小细胞肺癌肺叶切除术及肺叶部分切除术术后生存的Meta分析

Meta-analysis of postoperative survival of lobectomy and sublobectomy for stage Ⅰ non-small cell lung cancer

目的:通过对69篇文献数据进行Meta分析,讨论肺叶部分切除术是否适用于Ⅰ期非小细胞肺癌患者。方法:使用互联网搜索Ⅰ期非小细胞肺癌患者肺叶切除术、肺叶部分切除术、肺段切除术或肺楔状切除术之间相互比较进行生存分析的文献,从文献中提取危险比(HR)和其95%可信区间(CI),使用Stata MP 14进行Meta分析。结果:共收集69篇文献,发表日期从1980年至2016年,共有患者77 342例。肺叶部分切除术vs肺叶切除术中比较无瘤生存的文献共21篇,HR=1.008(95%CI:0.908～1.120,P=0.878),I2=28.8%,P(发表偏倚)=0.353。肺段切除术vs肺叶切除术中比较主动部分切除总生存文献共10篇,HR=1.021(95%CI:0.841～1.239,P=0.833),I2=0.0%,P(发表偏倚)=0.163。结论:通过Meta分析我们认为Ⅰ期非小细胞肺癌主动肺叶部分切除术可以获得与肺叶切除术近似的疗效,特别是主动肺段切除术。进而我们认为肺叶部分切除术在部分Ⅰ期非小细胞肺癌患者治疗中可以作为一种选择。

Objective： To discuss whether sublobectomy applies forⅠstage non-small cell lung cancer patients.Methods： We use the internet search literature about the survival difference following lobectomy,segmentectomy,and wedge resection in stage I non-small cell lung cancer patients. We extracted hazard ratio（ HR） and its 95% confidence interval（ CI） from the literatures and made Meta-analysis by Stata MP 14 software. Results： A total of 69 studies published from 1980 to 2016 enrolling 77 342 patients were included in this Meta-analysis. In sublobectomy vs lobectomy,a total of 2 1 studies are about recurrence-freesurvival,HR = 1. 0 0 8（ 9 5 % CI ： 0. 9 0 8 ~ 1. 1 2 0,P= 0. 878）,I2= 28. 8%,P（ publication bias） = 0. 353. In segmentectomy vs lobectomy,a total of 10 studies are about intentional sublobar resection overall survival,HR = 1. 021（ 95% CI： 0. 841 ~ 1. 239,P = 0. 833）,I2= 0. 0%,P（ publication bias） = 0. 163. Conclusion： Stage I lung cancer patients who underwent sublobectomy after intentional selection achieved comparable survival as those who received lobectomy. Furthermore we believe that sublobectomy in stageⅠ non-small cell lung cancer should be a good choice.