Meta-analysis of segmentectomy versus lobectomy for radiologically pure solid or solid-dominant stage IA non-small cell lung cancer

Abstract

ObjectiveWhether segmentectomy can be used to treat radiologically determined pure solid or solid-dominant lung cancer remains controversial owing to the invasive pathologic characteristics of these tumors despite their small size. This meta-analysis compared the oncologic outcomes after lobectomy and segmentectomy regarding relapse-free survival (RFS) and overall survival (OS) in patients with radiologically determined pure solid or solid-dominant clinical stage IA non-small cell lung cancer (NSCLC).MethodsA literature search was performed in the MEDLINE, EMBASE, and Cochrane Central databases for information from the date of database inception to March 2019. Studies were selected according to predefined eligibility criteria. The hazard ratio (HR) and associated 95% confidence interval (CI) were extracted or calculated as the outcome measure for data combining.ResultsSeven eligible studies published between 2014 and 2018 enrolling 1428 patients were included in the current meta-analysis. Compared with lobectomy, segmentectomy had a significant benefit on the RFS of radiologically determined pure solid or solid-dominant clinical stage IA NSCLC patients (combined HR: 1.46; 95% CI, 1.05–2.03; P = 0.024) and there were no significant differences on the OS of these patients (HR: 1.52; 95% CI, 0.95–2.43; P = 0.08).ConclusionsSegmentectomy leads to lower survival than lobectomy for clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors. Moreover, applying lobectomy to clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors (≤2 cm) could lead to an even bigger survival advantage. However, there are some limitations in the present study, and more evidence is needed to support the conclusion.

Circular RNA circSLC25A16 contributes to the glycolysis of non-small-cell lung cancer through epigenetic modification

“…Non-small-cell lung cancer (NSCLC) takes the largest proportion of lung cancer, the most common type of cancer, and acts as the leading cause of cancer-related mortality worldwide 1,2 . In early stage, NSCLC is usually asymptomatic, which delays the diagnosis of NSCLC.…”

How we assess the perioperative anxiety of surgical patients with pulmonary nodules: the revision of state-trait anxiety inventory

“…Lung cancer is still the most widespread and important malignant tumor at present, since it attributes over one eighth to the morbidity and nearly one quarter to the mortality in all malignant tumors [ 1 ]. Surgery is still the most effective treatment for patients with early-stage lung cancer [ 2 – 6 ]. At the beginning of twenty-first century, the concept of enhanced recovery after surgery (ERAS) emphasizes the integrated application of various methods to enhance perioperative management and promote postoperative recovery of patients as well, including pain relief, minimally invasive operation, and so on [ 7 – 11 ].…”

“…Our department intends to conduct a registry study to assess and intervene perioperative anxiety in patients undergoing pulmonary surgery. To this end, we asked the mental health specialists to help us develop a comprehensive preoperative relaxation training process including progressive muscle relaxation training and breathing relaxation training [ 2 , 14 , 17 – 19 ]. At the same time, by consulting the literature, we selected the commonly used State-Trait Anxiety Inventory (STAI) as an indicator to assess perioperative anxiety.…”

Current medical and surgical management of lung cancer

“…Segmentectomy has been accepted as a surgical approach for ground glass opacity dominant early stage non-small cell lung cancer and is associated with a good prognosis [20]. The use of segmentectomy for solid dominant lung tumours with radical intent however remains controversial [21]. A recent meta-analysis of 28 studies has shown superior results with VATS lobectomy compared with segmentectomy for tumours in stage I and IA whereas there were no signifi cant differences in oncological outcomes (hazard ratios, overall survival and cancer-specifi c survival) in tumours less than 2 cm [20].…”

“…A recent meta-analysis of 28 studies has shown superior results with VATS lobectomy compared with segmentectomy for tumours in stage I and IA whereas there were no signifi cant differences in oncological outcomes (hazard ratios, overall survival and cancer-specifi c survival) in tumours less than 2 cm [20]. A recent metanalysis demonstrated a higher risk of recurrence in the segmentectomy group compared with lobectomy though there was no statistical difference observed in overall survival [21]. To date there are three randomised control trials that compare lobectomy with segmentectomy.…”