Meta-analysis Of Intentional Sublobectomy Versus Lobectomy For Stage IA NSCLC

ABSTRACTObjective :With the wide use of high-tech equipments, an increasing number of non-small-cell lung cancers(NSCLCs) are diagnosed at the stage IA. Lobectomy was the radical standard surgical treatment for these patients over the past few decades, but now many doctors consider it to be overtreatment and call for the minimum effective treatment. The conflicting outcomes for sublobectomy versus lobectomies for stage IA NSCLC have been reported, sublobectomy remains controversial. This study evaluated the five-year overall survival, and recurrence-free survival(RFS) rate of intentional sublobectomy and lobectomy for stage IA NSCLC through a meta-analysis.Method: We conducted an electronic search using four databases. According to the predefined inclusion criteria, studies were selected and meta-analyzed by combing the log(hazard ratio, Ln(HR)) and its standard error(SE).Results:1 For stage IA NSCLC, eight studies were eligible for the inclusion criteria in which 755 patients underwent intentional sublobectomy and 1280 patients underwent lobectomy. There were no significant difference in OS(HR 0.74 [95% confidence interval(CI) 0.47-1.15])or RFS(HR 0.79;(95% CI 0.57-1.10)) between the two treatment methods.2 For Stage T1 a N0M0, six studies were included which 632 patients underwent intentional sublobectomy and 1045 patients underwent lobectomy, there was no significant difference in OS [HR 0.64; 95% confidence interval(CI) 0.39-1.05].Conclusion: Through analyzing the available literature data, for patients in stage IA NSCLC, especially for T1 a N0M0,(tumor diameter ≤2 cm), intentional sublobectomy resection maybe a strategy instead of lobectomy because of the similar long-term survival outcomes. Due to the selected chort, we expected the futural randomized comparison clinical trial can verify this conclusion.