肺段切除术与肺叶切除术治疗T1c期非小细胞肺癌的系统评价与Meta分析  

Survival outcomes of segmentectomy versus lobectomy for T1c non-small cell lung cancer:A systematic review and meta-analysis

作　　者：薛心雨 赵凯[1] 陈泞夙 李幼平[1] 喻佳洁[1,2] XUE Xinyu;ZHAO Kai;CHEN Ningsu;LI Youping;YU Jiajie(Research Center of Clinical Epidemiology and Evidence-Based Medicine,Chinese Evidence-Based Medicine Center,West China Hospital of Sichuan University,Chengdu,610041,P.R.China;Department of Clinical Nutrition,West China Hospital of Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院临床流行病学与循证医学研究中心/中国循证医学中心,成都610041 [2]四川大学华西医院临床营养科,成都610041

出　　处：《中国胸心血管外科临床杂志》2025年第3期393-400,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省自然科学基金面上项目(2023NSFC0520)。

摘　　要：目的系统评价肺段切除术与肺叶切除术治疗T1c期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效及安全性。方法系统检索PubMed、EMbase、Cochrane Central Register of Controlled Trials(CENTRAL)、中国知网、万方数据库,检索时限为建库至2024年2月。由3名研究人员独立筛选文献,提取相关资料并对纳入的文献依据纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)进行偏倚风险评价。采用STATA 15.1进行Meta分析。结果共纳入8个回顾性队列研究,发表于2004—2022年,共7433例患者。纳入研究NOS评分均≥7分。Meta分析结果显示,接受肺叶切除比接受肺段切除术患者的5年总生存率更高[校正HR=1.11,95%CI(0.99,1.24),P=0.042];两者3年总生存率[校正HR=0.88,95%CI(0.62,1.24)]、5年肺癌特异性生存率[校正HR=1.10,95%CI(0.80,1.51)]和5年无复发生存率[校正HR=1.23,95%CI(0.82,1.85)]差异均无统计学意义;接受肺段切除术患者不良事件发生风险低于肺叶切除术患者[OR=0.57,95%CI(0.37,0.90)]。亚组分析结果显示,在未纳入接受新辅助治疗患者的研究中,接受肺段切除术患者与接受肺叶切除患者5年总生存率差异无统计学意义[校正HR=1.02,95%CI(0.81,1.28)]。结论对于T1c期NSCLC患者,肺段切除术与肺叶切除术在长期生存方面差异无统计学意义,但接受肺段切除术的患者术后并发症发生率较低。未来还需要更多高质量的临床试验评估肺叶切除术与肺段切除术治疗T1c期NSCLC患者的有效性及安全性。Objective To evaluate the survival outcomes of segmentectomy versus lobectomy for T1c non-small cell lung cancer(NSCLC).Methods We searched PubMed,EMbase,Cochrane Central Register of Controlled Trials(CENTRAL),CNKI(China National Knowledge Infrastructure),and Wanfang Data,with the search time limit set from the inception of the databases to February 2024.Three researchers independently screened the literature,extracted relevant information,and evaluated the risk of bias of the included literature according to the Newcastle-Ottawa Scale(NOS).Meta-analysis was conducted using STATA 15.1.Results A total of 8 retrospective cohort studies were included,involving 7433 patients.The NOS scores of the included studies were all≥7 points.Patients who underwent lobectomy had significantly higher five-year overall survival(OS)rates compared to those who underwent segmentectomy(adjusted HR=1.11,95%CI 0.99-1.24,P=0.042).Compared with lobectomy,segmentectomy showed no significant difference in adjusted three-year OS rate(adjusted HR=0.88,95%CI 0.62-1.24)and adjusted five-year lung cancer-specific survival(adjusted HR=1.10,95%CI 0.80-1.51,P=0.556)of patients with T1c NSCLC.Moreover,there were no differences in the five-year adjusted relapse-free survival(adjusted HR=1.23,95%CI 0.82-1.85,P=0.319),and adverse events(OR=0.57,95%CI 0.37-0.90,P=0.015)in the segmentectomy group were significantly less than those in the lobectomy group.Subgroup analysis based on whether patients received neoadjuvant therapy showed that among studies that excluded patients who received neoadjuvant therapy,no significant difference in 5-year adjusted OS rate was observed between the segmentectomy group and lobectomy group(adjusted HR=1.02,95%CI 0.81-1.28,P=0.870).Conclusion Segmentectomy and lobectomy show no significant difference in long-term survival in stage T1c NSCLC patients,with segmentectomy associated with fewer postoperative complications.Further high-quality research is needed to confirm the comparative efficacy and safety of lobectomy and se

关 键 词：肺叶切除术 肺段切除术 T1c期 非小细胞肺癌 系统评价/META分析 

分 类 号：R73[医药卫生—肿瘤]