Sublobectomy versus lobectomy for stage I non-small-cell lung cancer, a meta-analysis of published studies

Abstract

Background: The selection of surgeries for patients with stage I NSCLC remains controversial. We evaluated the effectiveness of different surgeries for stage I NSCLC through a meta-analysis of studies that compared sublobectomy with lobectomy.

Methods: The overall survival/cancer-specific survival (OS/CSS) of stage I NSCLC after sublobectomy or lobectomy was compared. The log (hazard ratio) [ln (HR)] and its standard error (SE) were used as the outcome measure for data combining.

Results: There were 24 eligible studies, published from 1990 to 2010, enrolled (11,360 patients). Compared with sublobectomy, there was a significant benefit of lobectomy on OS and CSS of stage I NSCLC patients (HR 1.40; 95% confidence interval [95% CI], 1.15-1.69; P = .0006). In stage Ia patients with tumor no large than 2 cm, there were no differences in OS between lobectomy and sublobectomy (HR 0.81; 95% CI, 0.39-1.71; P = .58). For the comparison between lobectomy and segmentectomy, there was no significant difference on OS (HR = 1.09; 95% CI, 0.85-1.40; P = .45) and CSS (HR 0.99; 95% CI, 0.72-1.38; P = .97) in stage I NSCLC patients. There was no significant publication bias detected in any sections of the analysis.

Conclusions: For stage I patients, sublobectomy causes lower survival than lobectomy, whereas the outcomes of segmentectomy are comparable to that of lobectomy; for stage Ia patients with tumor ≤2 cm, sublobectomy produces similar survival to lobectomy.