Sublobectomy versus lobectomy for stage IA (T1a) non-small-cell lung cancer: a meta-analysis study.

Yaxin Liu,Cheng Huang,Hongsheng Liu,Shanqing Li,Yeye Chen

doi:10.1186/1477-7819-12-138

Abstract

BackgroundAlthough lobectomy is considered the standard surgical treatment for the majority of patients with non-small-cell lung cancer (NSCLC), the operation project for patients with stage IA NSCLC (T1a, tumor diameter ≤2 cm) remains controversial. Sublobectomy is appropriate only in certain patients as many doctors consider it to be overtreatment. We evaluated the five-year overall survival rate of sublobectomy and lobectomy for stage IA NSCLC (T1a, tumor diameter ≤2 cm) through a meta-analysis.MethodsThe five-year overall survival rate (OS) of stage IA (T1a) NSCLC after sublobectomy (including wedge resection and segmentectomy) and lobectomy were compared. We also compared the OS of stage IA (T1a) NSCLC after segmentectomy and lobectomy. The log (hazard ratio, ln (HR)) and its standard error (SE) were used as the outcome measure for data combining.ResultsThere were 12 eligible studies published between 1994 and 2013 in which the total number of participants was 18,720. When compared to lobectomy, there was a statistically significant difference of sublobectomy on OS of stage IA (T1a) NSCLC patients (HR 1.38; 95% confidence interval (95% CI), 1.19 to 1.61; P <0.0001). For the comparison between segmentectomy and lobectomy, there was also a statistically significant difference of segmentectomy alone on OS of stage IA (T1a) NSCLC patients (HR 1.48; 95% CI: 1.27 to 1.73; P <0.00001)ConclusionsWe have concluded that in stage IA (T1a) patients sublobectomy, including segmentectomy and wedge resection, causes a lower survival rate than lobectomy.

Highlights

Lobectomy is considered the standard surgical treatment for the majority of patients with non-small-cell lung cancer (NSCLC), the operation project for patients with stage IA non-small-cell lung cancers (NSCLCs) (T1a, tumor diameter ≤2 cm) remains controversial
The inclusion criteria were: (i) outcomes of interest include overall survival rate (OS) (ii) articles were peer-reviewed, published, and original articles (iii) information was described in the article on how the hazard ratio (HR) and standard error (SE) can be calculated (iv) study subjects had to be limited to clinical stage IA (T1a) patients, (v) patients were divided into lobectomy and sublobectomy, (vi) if the enrolled patients were from the same institutions and in the same period, only the most recently published data would be enrolled into the study
There were a total of 12 studies involved in the analysis that compared the impact of sublobectomy and lobectomy on OS of Stage IA (T1a) NSCLC patients

Summary

Introduction

Lobectomy is considered the standard surgical treatment for the majority of patients with non-small-cell lung cancer (NSCLC), the operation project for patients with stage IA NSCLC (T1a, tumor diameter ≤2 cm) remains controversial. Sublobectomy, including wedge resection and segmentectomy, In 1995, the Lung Cancer Study Group (LCSG) compared the outcomes of sublobar with lobar resection in a randomized trial and demonstrated that patients with sublobar resection had a lower survival rate [6]. The results from the LCSG have been further challenged by several retrospective studies, which have suggested that limited resection might be effective in the treatment of stage IA (T1a) patients with a tumor size of less than 2 cm compared with lobectomy, among elderly patients [9,10,11,12]

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Discussion

Conclusion