Sublobar Resection Versus Ablation for Stage I Non-Small-Cell Lung Cancer: A Meta-Analysis

Abstract

BackgroundStage I non-small-cell lung cancer (NSCLC) can be treated by both ablation and sublobar resection (SR). This meta-analysis was therefore designed to better compare the relative safety and efficacy of these two approaches to treating stage I NSCLC.Materials and MethodsRelevant studies published through November 2020 in the Cochrane Library, Embase, and PubMed databases were identified for analyses which were conducted with RevMan v5.3. ResultsIn total, 816 potentially relevant articles were identified, of which 8 were ultimately included in the final meta-analysis. Patients in the SR group exhibited a signficantly lower pooled local recurrence (LR) rate (5.0% vs. 25.4%, P < 0.0001), although pooled distant recurrence (DR) rates were similar in both groups (25.7% vs. 23.1%, P = 0.75). The pooled hazard ratio (HR) for overall survival (OS) (HR: 1.23; 95% CI: 1.13-1.33, P < 0.00001), progression-free survival (PFS) (HR: 1.34; 95% CI: 1.15-1.55, P = 0.0002), and cancer-specific survival (CSS) (HR: 1.39; 95% CI: 1.15-1.70, P = 0.0009) all indicated better survival outcomes among patients that underwent HR treatment, while pooled complication rates were similar in both groups (27.7% vs. 43.8%, P = 0.27). Patients that underwent ablation exhibited significantly shorter pooled post-operative hospitalization relative to those in the SR group (MD: 5.93; 95% CI: 0.78-11.07, P = 0.02). No evidence of publication bias was detected through funnel plot analyses.ConclusionsSR treatment of stage I NSCLC patients was associated with a lower LR rate and longer survival as compared to ablation.

Image-Guided Percutaneous and Transarterial Therapies for Primary and Metastatic Lung Cancer

“…To our knowledge, there has been only 1 systematic review and meta-analyses that compared surgery to ablation for patients with lung cancer. 49 Out of 816 potential articles, only 8 were included in this meta-analysis, resulted in enrollment of 679 patients treated by sublobar resection and 468 patients treated with ablation for stage I NSCLC. 49 The study found that the pooled OS, PFS, and cancer-specific survival rates were significantly higher in the sublobar resection group; however, this finding was associated with significant heterogeneity (I 2 of 73% for OS, 76% for PFS, and 74% for cancer-specific survival).…”

“…49 Out of 816 potential articles, only 8 were included in this meta-analysis, resulted in enrollment of 679 patients treated by sublobar resection and 468 patients treated with ablation for stage I NSCLC. 49 The study found that the pooled OS, PFS, and cancer-specific survival rates were significantly higher in the sublobar resection group; however, this finding was associated with significant heterogeneity (I 2 of 73% for OS, 76% for PFS, and 74% for cancer-specific survival). Additionally, pooled local recurrence rates were significantly higher in the ablation group than in the sublobar resection group (25.4% vs 5.0%, P < .0001; I 2 = 0%).…”