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Sublobar resection versus lobectomy for stage IA non-small-cell lung cancer ≤ 2 cm: a systematic review and patient-level meta-analysis

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Abstract

Despite lobectomy being the standard of care for early-stage non-small-cell lung cancer (NSCLC), sublobar resection (segmentectomy or wedge resection) has recently been suggested to achieve similar outcomes. An electronic literature search was conducted to retrieve randomized controlled trials (RCTs) or propensity score-matched studies (PSMs) comparing lobectomy to sublobar resection in stage IA NSCLC ≤ 2 cm in size, with provision of Kaplan–Meier curves for overall survival (OS) and disease-free survival (DFS). A graphical reconstructive algorithm was used to obtain OS and DFS of individual patients, which was then pooled under random-effects individual patient data meta-analysis using Cox models to determine hazard ratios (HRs). Sensitivity analyses for OS and DFS were also performed, restricting to results from RCTs only. Seven studies (2528 patients) were retrieved. There were no significant differences in OS (shared-frailty HR = 0.92, 95% CI = 0.77–1.11, p = 0.378) or DFS (shared-frailty HR = 1.06, 95% CI = 0.90–1.24, p = 0.476) between lobectomy and sublobar resection. This comparison remained non-significant even when restricted to RCTs only. Pooled Kaplan–Meier curves of OS appeared to diverge over time, in favor of sublobar resection. This was confirmed on analysis of restricted mean survival time curves. This patient-level meta-analysis of high-quality studies demonstrates that sublobar resection is equivalent to lobectomy in patients with small stage IA NSCLC. Sublobar resection offers greater down-the-road benefits in patients who experience recurrence or a second primary tumor since the lung-sparing index surgery allows patients to receive further treatment safely. This heralds sublobar resection as the new standard of care in carefully selected early-stage patients.

Trial registration: PROSPERO CRD42023385358.

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Data availability

This manuscript makes use of publicly available data from published studies; therefore, no additional data are available for sharing. The study protocol has been published on PROSPERO.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore

    Khi Yung Fong

  2. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Yiong Huak Chan

  3. Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore

    Cynthia Ming Li Chia

  4. Mount Elizabeth Medical Centre, Singapore, Singapore

    Thiruganam Agasthian

  5. Department of Respiratory and Critical Care Medicine, National University Hospital, Singapore, Singapore

    Pyng Lee

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  1. Khi Yung Fong
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Fong, K.Y., Chan, Y.H., Chia, C.M.L. et al. Sublobar resection versus lobectomy for stage IA non-small-cell lung cancer ≤ 2 cm: a systematic review and patient-level meta-analysis. Updates Surg 75, 2343–2354 (2023). https://doi.org/10.1007/s13304-023-01627-z

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