Segmentectomy versus lobectomy for stage ⅠA non-small cell lung cancer ≤2 cm: a systematic review and meta-analysis / 中华胸心血管外科杂志

ABSTRACT

Objective:We conducted a meta-analysis of related studies to compare the prognostic effects of the Lobectomy and segmental resection procedures for stage ⅠA 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 12 227 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 stage ⅠA 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.