Survival results of surgical resection versus CT-guided percutaneous ablation for stageⅠnon-small cell lung cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Guojun , ZHENG Yinbin ,  LUO Hui , WEN Bing

Department of Thoracic Surgery, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, 637000, Sichuan, P. R. China;

Corresponding author：

LUO Hui, Email: 392971805@qq.com

Keywords：

Non-small cell lung cancer; surgical resection; percutaneous ablation; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202104083

Video：

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Objective To evaluate the survival results of surgical resection (SR) and CT-guided percutaneous ablation (PA) for stageⅠnon-small cell lung cancer (NSCLC).Methods The PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP, Wanfang databases from inception to June 2021 were searched to collect comparative studies on the survival results between SR and CT-guided PA treatment for stageⅠNSCLC. RevMan 5.3 software was used for statistical analysis of data.Results A total of 3 114 patients were included in 11 studies. The results of meta-analysis showed that compared with the PA group, the SR group had a higher 2-year postoperative overall survival (OS) rate (OR=1.44, 95%CI 1.00-2.06, P=0.05), 3-year postoperative OS rate (OR=2.37, 95%CI 1.47-3.81, P<0.001), 5-year OS rate (OR=1.64, 95%CI 1.19-2.28, P<0.01), 5-year progression-free survival rate after operation (OR=2.43, 95%CI 1.54-3.82, P<0.001) and lower local recurrence rate (OR=0.26, 95%CI 0.13-0.54, P<0.001). There were no statistical differences between the two groups in terms of 1-year postoperative OS rate, 1-year, 2-year, and 3-year tumor-related survival rates, 1-year, 2-year tumor-free survival rates, or distant postoperative recurrence rate (P>0.05).Conclusion For patients with stageⅠNSCLC with optimal basic conditions, surgery is a more appropriate treatment. For patients who cannot withstand surgical injuries or refuse surgery, CT-guided PA is also a potential alternative treatment. However, this conclusion needs to be verified by prospective controlled trials with larger sample sizes and a more rigorous design.

Citation： WU Guojun, ZHENG Yinbin, LUO Hui, WEN Bing. Survival results of surgical resection versus CT-guided percutaneous ablation for stageⅠnon-small cell lung cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 903-909. doi: 10.7507/1007-4848.202104083 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Bade BC, Dela Cruz CS. Lung cancer 2020: Epidemiology, etiology, and prevention. Clin Chest Med, 2020, 41(1): 1-24.
3.	Postmus PE, Kerr KM, Oudkerk M, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2017, 28(suppl_4): Ⅳ1-Ⅳ21.1.
4.	Yuan XS, Chen WC, Lin QR, et al. A propensity-matched analysis of stereotactic body radiotherapy and sublobar resection for stageⅠnon-small cell lung cancer in patients at high risk for lobectomy: The results in a Chinese population. J Thorac Dis, 2021, 13(3): 1822-1832.
5.	Mimae T, Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer? Thorac Cardiovasc Surg, 2020, 68(7): 703-706.
6.	Gao Y, Chen J, Zhang J, et al. Radiofrequency ablation of primary non-small cell lung cancer: A retrospective study on 108 patients. J BUON, 2019, 24(4): 1610-1618.
7.	Crocetti L, Bargellini I, Cioni R. Loco-regional treatment of HCC: current status. Clin Radiol, 2017, 72(8): 626-635.
8.	Cao F, Xie L, Qi H, et al. Safety and efficacy of thermal ablation for subpleural lung cancers. Thorac Cancer, 2019, 10(6): 1340-1347.
9.	Li G, Xue M, Chen W, et al. Efficacy and safety of radiofrequency ablation for lung cancers: A systematic review and meta-analysis. Eur J Radiol, 2018, 100: 92-98.
10.	Wells GA, Shea B, O'Connell D, et al. The Newcastle Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
11.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
12.	Alexander ES, Machan JT, Ng T, et al. Cost and effectiveness of radiofrequency ablation versus limited surgical resection for stage Ⅰ non-small-cell lung cancer in elderly patients: Is less more? J Vasc Interv Radiol, 2013, 24(4): 476-482.
13.	Ambrogi MC, Fanucchi O, Dini P, et al. Wedge resection and radiofrequency ablation for stageⅠnonsmall cell lung cancer. Eur Respir J, 2015, 45(4): 1089-1097.
14.	Hu H, Zhai B, Liu R, et al. Microwave ablation versus wedge resection for stageⅠ non-small cell lung cancer adjacent to the pericardium: Propensity score analyses of long-term outcomes. Cardiovasc Intervent Radiol, 2021, 44(2): 237-246.
15.	Iguchi T, Hiraki T, Matsui Y, et al. Survival outcomes of treatment with radiofrequency ablation, stereotactic body radiotherapy, or sublobar resection for patients with clinical stageⅠnon-small-cell lung cancer: A single-center evaluation. J Vasc Interv Radiol, 2020, 31(7): 1044-1051.
16.	Kim SR, Han HJ, Park SJ, et al. Comparison between surgery and radiofrequency ablation for stageⅠnon-small cell lung cancer. Eur J Radiol, 2012, 81(2): 395-399.
17.	Kwan SW, Mortell KE, Talenfeld AD, et al. Thermal ablation matches sublobar resection outcomes in older patients with early-stage non-small cell lung cancer. J Vasc Interv Radiol, 2014, 25(1): 1-9.
18.	Safi S, Rauch G, op den Winkel J, et al. Sublobar resection, radiofrequency ablation or radiotherapy in stageⅠnon-small cell lung cancer. Respiration, 2015, 89(6): 550-557.
19.	Wang Y, Liu B, Cao P, et al. Comparison between computed tomography-guided percutaneous microwave ablation and thoracoscopic lobectomy for stageⅠnon-small cell lung cancer. Thorac Cancer, 2018, 9(11): 1376-1382.
20.	Yao W, Lu M, Fan W, et al. Comparison between microwave ablation and lobectomy for stageⅠnon-small cell lung cancer: A propensity score analysis. Int J Hyperthermia, 2018, 34(8): 1329-1336.
21.	Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stageⅠnon-small cell lung cancer. J Am Coll Surg, 2010, 211(1): 68-72.
22.	侯立泳, 高兴强, 王永, 等. 经皮微波消融与胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌的疗效. 介入放射学杂志, 2019, 28(9): 851-854.
23.	郑鑫林, 夏学阳, 张金周, 等. 胸腔镜下肺段切除与肺叶切除治疗临床Ⅰ期非小细胞肺癌疗效对比的Meta分析. 中国癌症杂志, 2016, 26(10): 854-860.
24.	覃帮能, 刘触灵. CT诊断非小细胞肺癌TNM分期的临床价值. 重庆医学, 2017, 46(31): 4406-4408.
25.	吴鹏, 庞瑶, 张宏毅, 等. 手术和射频消融治疗Ⅰ期非小细胞肺癌预后比较的Meta分析. 中华胸部外科电子杂志, 2020, 7(3): 164-173.
26.	Aufranc V, Farouil G, Abdel-Rehim M, et al. Percutaneous thermal ablation of primary and secondary lung tumors: Comparison between microwave and radiofrequency ablation. Diagn Interv Imaging, 2019, 100(12): 781-791.
27.	Palussiere J, Lagarde P, Aupérin A, et al. Percutaneous lung thermal ablation of non-surgical clinical N0 non-small cell lung cancer: Results of eight years' experience in 87 patients from two centers. Cardiovasc Intervent Radiol, 2015, 38(1): 160-166.
28.	Yuan Z, Wang Y, Zhang J, et al. A Meta-analysis of clinical outcomes after radiofrequency ablation and microwave ablation for lung cancer and pulmonary metastases. J Am Coll Radiol, 2019, 16(3): 302-314.
29.	Sharma A, Abtin F, Shepard JA. Image-guided ablative therapies for lung cancer. Radiol Clin North Am, 2012, 50(5): 975-999.
30.	Ozturk A, Gullu YT. Excellence in non-small cell lung cancer staging by endobronchial-TBNA: Comparison with PET-CT and surgery. Minim Invasive Ther Allied Technol, 2019, 28(4): 213-219.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Bade BC, Dela Cruz CS. Lung cancer 2020: Epidemiology, etiology, and prevention. Clin Chest Med, 2020, 41(1): 1-24.
3. Postmus PE, Kerr KM, Oudkerk M, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2017, 28(suppl_4): Ⅳ1-Ⅳ21.1.
4. Yuan XS, Chen WC, Lin QR, et al. A propensity-matched analysis of stereotactic body radiotherapy and sublobar resection for stageⅠnon-small cell lung cancer in patients at high risk for lobectomy: The results in a Chinese population. J Thorac Dis, 2021, 13(3): 1822-1832.
5. Mimae T, Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer? Thorac Cardiovasc Surg, 2020, 68(7): 703-706.
6. Gao Y, Chen J, Zhang J, et al. Radiofrequency ablation of primary non-small cell lung cancer: A retrospective study on 108 patients. J BUON, 2019, 24(4): 1610-1618.
7. Crocetti L, Bargellini I, Cioni R. Loco-regional treatment of HCC: current status. Clin Radiol, 2017, 72(8): 626-635.
8. Cao F, Xie L, Qi H, et al. Safety and efficacy of thermal ablation for subpleural lung cancers. Thorac Cancer, 2019, 10(6): 1340-1347.
9. Li G, Xue M, Chen W, et al. Efficacy and safety of radiofrequency ablation for lung cancers: A systematic review and meta-analysis. Eur J Radiol, 2018, 100: 92-98.
10. Wells GA, Shea B, O'Connell D, et al. The Newcastle Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
11. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
12. Alexander ES, Machan JT, Ng T, et al. Cost and effectiveness of radiofrequency ablation versus limited surgical resection for stage Ⅰ non-small-cell lung cancer in elderly patients: Is less more? J Vasc Interv Radiol, 2013, 24(4): 476-482.
13. Ambrogi MC, Fanucchi O, Dini P, et al. Wedge resection and radiofrequency ablation for stageⅠnonsmall cell lung cancer. Eur Respir J, 2015, 45(4): 1089-1097.
14. Hu H, Zhai B, Liu R, et al. Microwave ablation versus wedge resection for stageⅠ non-small cell lung cancer adjacent to the pericardium: Propensity score analyses of long-term outcomes. Cardiovasc Intervent Radiol, 2021, 44(2): 237-246.
15. Iguchi T, Hiraki T, Matsui Y, et al. Survival outcomes of treatment with radiofrequency ablation, stereotactic body radiotherapy, or sublobar resection for patients with clinical stageⅠnon-small-cell lung cancer: A single-center evaluation. J Vasc Interv Radiol, 2020, 31(7): 1044-1051.
16. Kim SR, Han HJ, Park SJ, et al. Comparison between surgery and radiofrequency ablation for stageⅠnon-small cell lung cancer. Eur J Radiol, 2012, 81(2): 395-399.
17. Kwan SW, Mortell KE, Talenfeld AD, et al. Thermal ablation matches sublobar resection outcomes in older patients with early-stage non-small cell lung cancer. J Vasc Interv Radiol, 2014, 25(1): 1-9.
18. Safi S, Rauch G, op den Winkel J, et al. Sublobar resection, radiofrequency ablation or radiotherapy in stageⅠnon-small cell lung cancer. Respiration, 2015, 89(6): 550-557.
19. Wang Y, Liu B, Cao P, et al. Comparison between computed tomography-guided percutaneous microwave ablation and thoracoscopic lobectomy for stageⅠnon-small cell lung cancer. Thorac Cancer, 2018, 9(11): 1376-1382.
20. Yao W, Lu M, Fan W, et al. Comparison between microwave ablation and lobectomy for stageⅠnon-small cell lung cancer: A propensity score analysis. Int J Hyperthermia, 2018, 34(8): 1329-1336.
21. Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stageⅠnon-small cell lung cancer. J Am Coll Surg, 2010, 211(1): 68-72.
22. 侯立泳, 高兴强, 王永, 等. 经皮微波消融与胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌的疗效. 介入放射学杂志, 2019, 28(9): 851-854.
23. 郑鑫林, 夏学阳, 张金周, 等. 胸腔镜下肺段切除与肺叶切除治疗临床Ⅰ期非小细胞肺癌疗效对比的Meta分析. 中国癌症杂志, 2016, 26(10): 854-860.
24. 覃帮能, 刘触灵. CT诊断非小细胞肺癌TNM分期的临床价值. 重庆医学, 2017, 46(31): 4406-4408.
25. 吴鹏, 庞瑶, 张宏毅, 等. 手术和射频消融治疗Ⅰ期非小细胞肺癌预后比较的Meta分析. 中华胸部外科电子杂志, 2020, 7(3): 164-173.
26. Aufranc V, Farouil G, Abdel-Rehim M, et al. Percutaneous thermal ablation of primary and secondary lung tumors: Comparison between microwave and radiofrequency ablation. Diagn Interv Imaging, 2019, 100(12): 781-791.
27. Palussiere J, Lagarde P, Aupérin A, et al. Percutaneous lung thermal ablation of non-surgical clinical N0 non-small cell lung cancer: Results of eight years' experience in 87 patients from two centers. Cardiovasc Intervent Radiol, 2015, 38(1): 160-166.
28. Yuan Z, Wang Y, Zhang J, et al. A Meta-analysis of clinical outcomes after radiofrequency ablation and microwave ablation for lung cancer and pulmonary metastases. J Am Coll Radiol, 2019, 16(3): 302-314.
29. Sharma A, Abtin F, Shepard JA. Image-guided ablative therapies for lung cancer. Radiol Clin North Am, 2012, 50(5): 975-999.
30. Ozturk A, Gullu YT. Excellence in non-small cell lung cancer staging by endobronchial-TBNA: Comparison with PET-CT and surgery. Minim Invasive Ther Allied Technol, 2019, 28(4): 213-219.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Survival results of surgical resection versus CT-guided percutaneous ablation for stageⅠnon-small cell lung cancer: A systematic review and meta-analysis

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