Sublobectomy Versus Lobectomy for Stage I Non-Small-Cell Lung Cancer, A Meta-Analysis of Published Studies

• Published in: Annals of surgical oncology 2012-02, Vol.19 (2), p.661-668
• Main Authors: Fan, Jiang, Wang, Lei, Jiang, Ge-Ning, Gao, Wen
• Format: Article
• Language: English
• Subjects: Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - surgery; Humans; Lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Medicine; Medicine & Public Health; Neoplasm Staging; Oncology; Pneumonectomy - mortality; Review Literature as Topic; Surgery; Surgical Oncology; Survival Rate; Thoracic Oncology; Treatment Outcome
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-011-1931-9

Background The selection of surgeries for patients with stage I NSCLC remains controversial. We evaluated the effectiveness of different surgeries for stage I NSCLC through a meta-analysis of studies that compared sublobectomy with lobectomy. Methods The overall survival/cancer-specific survival (OS/CSS) of stage I NSCLC after sublobectomy or lobectomy was compared. The log (hazard ratio) [ln (HR)] and its standard error (SE) were used as the outcome measure for data combining. Results There were 24 eligible studies, published from 1990 to 2010, enrolled (11,360 patients). Compared with sublobectomy, there was a significant benefit of lobectomy on OS and CSS of stage I NSCLC patients (HR 1.40; 95% confidence interval [95% CI], 1.15–1.69; P  = .0006). In stage Ia patients with tumor no large than 2 cm, there were no differences in OS between lobectomy and sublobectomy (HR 0.81; 95% CI, 0.39–1.71; P  = .58). For the comparison between lobectomy and segmentectomy, there was no significant difference on OS (HR = 1.09; 95% CI, 0.85–1.40; P  = .45) and CSS (HR 0.99; 95% CI, 0.72–1.38; P  = .97) in stage I NSCLC patients. There was no significant publication bias detected in any sections of the analysis. Conclusions For stage I patients, sublobectomy causes lower survival than lobectomy, whereas the outcomes of segmentectomy are comparable to that of lobectomy; for stage Ia patients with tumor ≤2 cm, sublobectomy produces similar survival to lobectomy.