XUE Xinyu 1 , ZHAO Kai 1 , CHEN Ningsu 1 , LI Youping 1 , YU Jiajie 1,2
  • 1. Research Center of Clinical Epidemiology and Evidence Based Medicine, West China Hospital of Sichuan University, Chengdu, 610041, P. R. China;
  • 2. Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, 610041, P. R. China;
YU Jiajie, Email: 2003xiong@163.com
Lobectomy; segmentectomy; stage T1c; non-small cell lung cancer; meta-analysis
10.7507/1007-4848.202404016
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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. Hazard ratios (HRs) and their 95% confidence interval were pooled using an inverse variance-weighted approach, and heterogeneity was assessed using I-square (I2) statistic and Cochran’s Q test. Results  A total of 8 retrospective cohort studies were included, involving 7,433 patients. The NOS scores of the included studies were all higher than 7 points. Among the 7 433 patients enrolled in eight eligible studies published from 2004 to 2022. The pooled adjusted HR found that patients who underwent lobectomy had significantly higher five-year OS compared to those who underwent lobectomy (adjusted HR=1.11, 95%CI 0.99-1.24, P=0.042). Compared with lobectomy, segmentectomy shows no significant difference in adjusted three-year OS and adjusted five-year LCSS of patients with T1c NSCLC (three-year OS: adjusted HR=0.88, 95%CI 0.62-1.24, P=0.468; five-year LCSS: adjusted HR=1.10, 95%CI 0.80-1.51, P=0.556). Moreover, there were no differences in the five-year adjusted RFS, and adverse events after the segmentectomy group were significantly less than those in the lobectomy group (five-year RFS: adjusted HR=1.23, 95%CI 0.82 to 1.85, P=0.319; complications: OR=0.57, 95%CI0.37 to 0.90, P=0.015). 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 was observed between segmentectomy and lobectomy (adjusted HR=1.02, 95%CI 0.81 to 1.28, P=0.870). Conclusion  Segmentectomy and lobectomy showed 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 segmentectomy for T1c NSCLC patients.