Abstract
ObjectiveWhether segmentectomy can be used to treat radiologically determined pure solid or solid-dominant lung cancer remains controversial owing to the invasive pathologic characteristics of these tumors despite their small size. This meta-analysis compared the oncologic outcomes after lobectomy and segmentectomy regarding relapse-free survival (RFS) and overall survival (OS) in patients with radiologically determined pure solid or solid-dominant clinical stage IA non-small cell lung cancer (NSCLC).MethodsA literature search was performed in the MEDLINE, EMBASE, and Cochrane Central databases for information from the date of database inception to March 2019. Studies were selected according to predefined eligibility criteria. The hazard ratio (HR) and associated 95% confidence interval (CI) were extracted or calculated as the outcome measure for data combining.ResultsSeven eligible studies published between 2014 and 2018 enrolling 1428 patients were included in the current meta-analysis. Compared with lobectomy, segmentectomy had a significant benefit on the RFS of radiologically determined pure solid or solid-dominant clinical stage IA NSCLC patients (combined HR: 1.46; 95% CI, 1.05–2.03; P = 0.024) and there were no significant differences on the OS of these patients (HR: 1.52; 95% CI, 0.95–2.43; P = 0.08).ConclusionsSegmentectomy leads to lower survival than lobectomy for clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors. Moreover, applying lobectomy to clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors (≤2 cm) could lead to an even bigger survival advantage. However, there are some limitations in the present study, and more evidence is needed to support the conclusion.
Highlights
The development and widespread use of computed tomography (CT) for lung cancer screening has enabled an increasing ability to detect small lung nodules [1]
It is acknowledged that Ground-glass opacity (GGO) (Ground glass opacity)-dominant early-stage non-small cell lung cancer (NSCLC) is associated with a good prognosis [5,6,7,8,9,10] and can be treated with sublobar resection, because these tumors are minimally invasive [9,10,11]
Two recent studies [16, 17] suggested that the relapse-free survival (RFS) and overall survival (OS) were lower after segmentectomy than after lobectomy for radiologically determined solid clinical IA (≤2 cm) NSCLC, and segmentectomy was considered an independent risk factor for poor locoregional recurrence-free survival in a multivariate analysis
Summary
The development and widespread use of computed tomography (CT) for lung cancer screening has enabled an increasing ability to detect small lung nodules [1]. Two recent studies [16, 17] suggested that the RFS and OS were lower after segmentectomy than after lobectomy for radiologically determined solid clinical IA (≤2 cm) NSCLC, and segmentectomy was considered an independent risk factor for poor locoregional recurrence-free survival in a multivariate analysis. These results indicate that intentional segmentectomy may not be applicable for small radiographically determined invasive NSCLC. The use of segmentectomy for solid-dominant or pure solid tumors as a radical procedure is controversial
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