| Objectives To evaluate the perioperative and long-term survival of thoracoscopic segmental pneumonectomy and lobectomy(LBCT)in patients with stage pⅠA NSCLC over 60 years old.The clinical efficacy of LBCT,sublobar resection(SR);surgical resection and stereotactic body radiotherapy(SBRT)in the treatment of elderly stage I NSCLC was evaluated by meta-analysis system,in order to provide basis for clinical research and practice.Methods The clinical data of p IA stage NSCLC patients over 60 years old in the Cardiothoracic Surgery Department of the First Affiliated Hospital of Guangxi Medical University were collected(limited from April 2015 to December 2017),and they were divided into VATS-assisted segmentectomy group and LBCT group according to different surgical methods,using univariate,multivariate Logistic linear regression analysis of risk factors affecting surgical complications and prognosis,Kaplan-Meier method for survival analysis.Search various Chinese and foreign literature databases,including CNKI,VIP.com,Wanfang Data Knowledge Service Platform,China Biomedical Literature Database,EMBASE,Cochrane Library databases,Web of Science and Pub Med,and assist other searches(From the establishment of the database to October 2021);as well as other auxiliary retrieval to collect all randomized controlled trials(RCTs)and retrospective clinical case-control studies on LBCT and SR in the treatment of elderly stage p IA NSCLC.All RCT studies and clinical cases of surgical resection and SBRT in the treatment of elderly stage I NSCLC were retrospectively analyzed.The implementation quality evaluation mainly refers to the Cochrane quality evaluation standard,and the effect size is combined by(Revman 5.3 software and Stata version 15.0software)。Results Ultimately,146 patients were enrolled in this study,including 81 in the LBCT group and 65 in the segmentectomy group。The operation time and intraoperative blood loss of the segmentectomy group were less than those of the LBCT group(P<0.05),the number of lymph node dissection was better(P<0.05),and the chest catheter indwelling time was longer(P<0.05),the postoperative persistent air leak rate was lower(P<0.05)。According to multivariate Logistic regression analysis,operation time was a risk factor for postoperative complications(OR=1.013,95% CI: 1.003-1.023)。Log-Rank analysis found that smoking was associated with postoperative recurrence(P < 0.05).In a systematic review of LBCT and SR: a total of 1024 patients were included in the study,from 1 RCT study and 9 retrospective clinical controlled studies;long-term efficacy results analysis showed that compared with the SR group,the LBCT group had better overall survival(OS)after surgery(OR=2.16,95%CI:1.19-3.94,P=0.01).Combined analysis of the effect size of chest catheter indwelling time and postoperative hospital stay showed that the LBCT group was significantly longer than the SR group(OR=0.40,95%CI: 0.16-0.64,P=0.0009;OR=0.89,95%CI: 0.26-1.52,P=0.006);the incidence of postoperative atelectasis in the LBCT group was significantly higher than that in the SR group(OR=2.66,95%CI: 1.10-6.44,P =0.03)。 Systematic review of SBRT comparing surgical treatment: 7 clinical retrospective studies(924patients in total)were included 。 In terms of the primary outcome measure,3-year and 5-year OS,SBRT was significantly inferior to surgical resection(OR=0.56,95%CI: 0.34-0.92,P=0.02;OR=0.55,95%CI: 0.38-0.79,P=0.001);In terms of the secondary outcome indicators,in the cancer-specific Survival(CSS),local control rate(LRC)and local recurrence,the combined analysis of the effect size showed that the two groups were similar,with no statistical difference.Conclusions Compared with LBCT,thoracoscopic segmentectomy could be adopted for patients aged over 70 years old or unable to tolerate LBCT,Implementing standard anatomical segmentectomy is an important prerequisite for ensuring long-term postoperative outcomes;There is a certain internal relationship between tumor recurrence and smoking.More attention should be paid to such elderly patients,and regular follow-up outside the hospital should be strengthened.The curative effect of SR is not inferior to that of LBCT,especially for patients aged more than 65 years old,the improvement of postoperative pulmonary function is obvious;Compared with surgical treatment,SBRT has obvious advantages,and is not restricted by the basic conditions of patients.For stage I NSCLC with standard surgical risk,surgery is the first choice,and SBRT is not recommended。... |
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