Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stage I non-small cell lung cancer: a meta-analysis.
Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stage I non-small cell lung cancer: a meta-analysis.
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DOI：
10.1177/1753465816667121
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发表时间：
2016-10
影响因子：
4.3
通讯作者：
Dai JG
中科院分区：
文献类型：
--
作者：
Hou B;Deng XF;Zhou D;Liu QX;Dai JG
虽然肺叶切除术仍然是I期非小细胞肺癌（NSCLC）患者的首选治疗方法，但肺段切除术或楔形切除术经常用于无法承受肺叶切除术生理严酷性的患者。本研究的目的是比较接受这些手术的I期NSCLC患者的总生存期（OS）、癌症特异性生存期（CSS）和无病生存期结局。在三个在线数据库中进行了系统的电子检索，从最早的出版日期到2015年6月。根据严格的、预定义的纳入标准对研究进行评价。使用风险比（HR）作为数据合并的结局指标。共有9项合格研究。这些研究包括1181例接受肺段切除术的患者和2003例接受楔形切除术的患者。接受肺段切除术的I期NSCLC患者的OS（HR 0.80; 95%置信区间[CI]，0.68-0.93; p = 0.004）和CSS（HR 0.42; 95% CI，0.20-0.88; p = 0.02）率显著优于接受楔形切除术的患者。然而，在肿瘤大小> 2 cm的Ia期NSCLC患者中，肺段切除术和楔形切除术之间的OS（HR 0.39; 95% CI，0.15-1.02; p = 0.06）和CSS（HR 1.87; 95% CI，0.29-12.06; p = 0.51）率无显著差异。对于I期NSCLC患者，肺段切除术的生存率高于楔形切除术，而对于肿瘤大小≥ 2 cm的Ia期NSCLC患者，楔形切除术的结局与肺段切除术相当。考虑到纳入研究的局限性和异质性，这一结论还需通过严格的随机临床试验进一步证实。
Although lobectomy is still the preferred treatment for patients with stage I non-small cell lung cancer (NSCLC), segmentectomy or wedge resection is frequently performed on patients who cannot withstand the physiological rigors of lobectomy. The objective of this study was to compare the overall survival (OS), cancer-specific survival (CSS), and disease-free survival outcomes among patients with stage I NSCLC who have undergone these procedures. A systematic electronic search in three online databases was conducted from their earliest publication dates to June 2015. The studies were evaluated according to rigorous, predefined inclusion criteria. The hazard ratio (HR) was used as the outcome measure for data combining. There were nine eligible studies. These studies included 1181 patients who underwent segmentectomy and 2003 patients who underwent wedge resection. Stage I NSCLC patients who underwent segmentectomy had significantly better OS (HR 0.80; 95% confidence interval [CI], 0.68–0.93; p = 0.004) and CSS (HR 0.42; 95% CI, 0.20–0.88; p = 0.02) rates than those who underwent wedge resection. However, there were no significant differences in OS (HR 0.39; 95% CI, 0.15–1.02; p = 0.06) and CSS (HR 1.87; 95% CI, 0.29–12.06; p = 0.51) rates between segmentectomy and wedge resection in patients with stage Ia NSCLC with tumor size ⩽ 2 cm. For patients with stage I NSCLC, segmentectomy results in higher survival rates than wedge resection, whereas the outcomes of wedge resection are comparable to those of segmentectomy for patients with stage Ia NSCLC with tumor size ⩽ 2 cm. Considering the limitations and heterogeneity of the included studies, this conclusion should be further confirmed by rigorous randomized clinical trials.
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影响因子：
3.4
作者：
Sugi, Kazuro;Kobayashi, Seiki;Okabe, Kazunori
通讯作者：
Okabe, Kazunori
影响因子：
6
作者：
Koike, T;Yamato, Y;Suzuki, R
通讯作者：
Suzuki, R
影响因子：
2.5
作者：
Tierney JF;Stewart LA;Ghersi D;Burdett S;Sydes MR
通讯作者：
Sydes MR
DOI：
10.1093/jnci/djn389
发表时间：
2008-12-03
期刊：
Journal of the National Cancer Institute
影响因子：
--
作者：
Jemal A;Thun MJ;Ries LA;Howe HL;Weir HK;Center MM;Ward E;Wu XC;Eheman C;Anderson R;Ajani UA;Kohler B;Edwards BK
通讯作者：
Edwards BK
影响因子：
9.6
作者：
Kates, Max;Swanson, Scott;Wisnivesky, Juan P.
通讯作者：
Wisnivesky, Juan P.