肺段切除术与肺叶切除术治疗≤2 cm的ⅠA期非小细胞肺癌:一项系统回顾和荟萃分析

Segmentectomy versus lobectomy for stageⅠA non-small cell lung cancer≤2 cm:a systematic review and meta-analysis

目的比较肺叶切除术和肺段切除术治疗早期非小细胞肺癌(NSCLC)对患者预后的影响。方法相关文献来自Pubmed、Web of science、EMBASE、The Cochrane Library、CNKI、CBM、VIP和万方等数据库。从纳入的研究中直接提取或间接计算肺段切除术组与肺叶切除术组的相关数据。结果2001年至2022年间发表的30项研究,共纳入12227例患者。与肺叶切除术相比,肺段切除术对术前CT影像确定为≤2 cm的NSCLC患者的3年总生存率(OS)有显著益处(OR=0.86,95%CI:0.75~1.00,P=0.05),患者的5年OS(OR=0.91,95%CI:0.76~1.09,P=0.30)和10年OS(OR=1.22,95%CI:0.67~2.21,P=0.51)差异无统计学意义。患者的3年无进展生存率(PFS)(OR=0.87,95%CI:0.67~1.13,P=0.30)和5年PFS(OR=0.87,95%CI:0.69~1.10,P=0.26)差异无统计学意义。亚组分析中,患者的3年及5年肺癌特异性生存率(LCSS)差异无统计学意义。结论在≤2 cm的ⅠA期周围型NSCLC手术的比较中,肺段切除术在远期生存率及无进展生存期均展现其非劣性,或许可作为推荐的手术选择。但10年远期生存率及实性成分分析,仍需进一步随机对照研究及更长时间的回顾性分析。

Objective We conducted a meta-analysis of related studies to compare the prognostic effects of the Lobectomy and segmental resection procedures for stageⅠA non-small cell lung cancer≤2 cm.Methods Relevant literatures were obtained from Pubmed,Web of Science,EMBASE,The Cochrane Library,CNKI,CBM,VIP and Wanfang databases.Inclusion and exclusion criteria were identified to screen articles for further systematic review and meta-analysis.Data related to segmentectomy group and lobectomy group were directly extracted or indirectly calculated from the included studies.Results The current meta-analysis included 30 studies involving 12227 patients published from the establishment of the database to 2022.Compared with lobectomy,segmentectomy had a significant benefit on 3-year OS in patients with NSCLC whose preoperative CT image was≤2 cm(OR=0.86,95%CI:0.75-1.00,P=0.05),there was no significant difference in 5-year OS(OR=0.91,95%CI:0.76-1.09,P=0.30)10-year OS(OR=1.22,95%CI:0.67-2.21,P=0.51)among these patients.In the study of progression-free survival,patients had 3-year PFS(OR=0.87,95%CI:0.67-1.13,P=0.30),5-year PFS(OR=0.87,95%CI:0.69-1.10,P=0.26),had no significant difference in PFS.In the subgroup analysis,there was no significant difference between the 3-and 5-year LCSS.Conclusion Our findings suggest that lobectomy is not superior to segmentectomy for stageⅠA NSCLC≤2cm in terms of both long-term survival and progression-free survival,and may be the recommended surgical option.However,further randomized controlled studies and longer period of retrospective analysis are still needed for 10-year long-term survival and solid component analysis.