Comparison Of Lobe-specific Node Dissection And Systemic Lymph Node Dissection For Early Stage Non-small Cell Lung Cancer:A Meta-analysis

Objective:For non-small cell lung cancer(NSCLC),it is still controversial which is the best option:lung lobe specific lymph node dissection(LND)or systemic lymph node dissection(SND).Therefore,we performed an updated and comprehensive Meta-analysis to compare the clinical efficacy and prognosis of lung lobe specific lymph node dissection versus systemic lymph node dissection in patients with early stage NSCLC.Methods:By searching Pubmed,Cochran Library,Embase,Web of Science and Proquest databases,we extracted relevant literature on the efficacy and prognosis of lung lobe specific lymph node dissection and systemic lymph node dissection for early stage NSCLC,and after the process of screening,quality evaluation,and data extraction,we conducted Meta-analysis for relevant outcome indicators[overall survival(OS),disease-free survival(DFS),complications,and recurrence rate]using statistical methods to draw conclusions.Result:After an initial search yielded 215 relevant publications,10 retrospective studies and 1randomized controlled trial(RCT)were included in the final analysis after removing duplicate articles and assessing eligibility for inclusion.A total of 9699 patients were included in the Meta-analysis,including 3068 patients in the lung lobe specific lymph node dissection group and6631 patients in the systemic lymph node dissection group.Final results of the Meta-analysis:there was no significant difference in 5-year survival(OS)between patients in the lung lobe specific lymph node dissection(LND)group and those in the systemic lymph node dissection(SND)group(RR=1.02;95%CI,0.99-1.06;P=0.12>0.05;I~2=22%).In terms of complications,there was also no significant difference between lung lobe specific lymph node dissection(LND)and systemic lymph node dissection(SND)(RR=0.88;95%CI:0.76-1.01;P=0.08>0.05;I~2=30%).However,disease-free survival(DFS)was higher in the lobe-specific lymph node dissection(LND)group than in the systemic lymph node dissection(SND)group(RR=1.07;95%CI,1.02-1.13;P=0.01,I~2=16%),and patients treated with lobe-specific lymph nodes(LND)had a significantly lower recurrence rate than those treated with systemic lymph node dissection(SND)(RR=0.84,95%CI:0.77-0.92,P=0.003<0.05,I~2=0).Conclusions:Compared with previous Meta-analyses,we removed individual articles with a large effect on heterogeneity by sensitivity analysis during the analysis,which greatly reduced the heterogeneity and increased the credibility of the results.For specific patients,lung lobe specific lymph node dissection can achieve the same prognosis as systemic lymph node dissection,if not better.However,these results should be treated with caution due to selection bias in the included studies.Until there is more clinical research evidence to support lobe-specific lymph node dissection,systemic lymph node dissection is the best option for the vast majority of patients with early-stage NSCLC.More prospective studies are needed in the future to further validate our conclusions.