Abstract
Objective
Multiple cohort studies have compared surgical resection with CT-guided percutaneous ablation for patients with stage 1 non-small cell lung cancer (NSCLC); however, the results have been heterogeneous. This systematic review and meta-analysis aims to compare surgery with ablation for stage 1 NSCLC.
Method
A search of five databases was performed from inception to 5 July 2020. Studies were included if overall survival (OS), cancer-specific survival (CSS), and/or disease-free survival (DFS) were compared between patients treated with surgical resection versus ablation (radiofrequency ablation (RFA) or microwave ablation (MWA)) for stage 1 NSCLC. Pooled odds ratios (OR) were calculated.
Results
A total of eight studies were included (total 792 patients: 460 resection and 332 ablation). There were no significant differences in 1- to 5-year OS or CSS between surgery versus ablation. There were significantly better 1- and 2-year DFS for surgery over ablation (OR 2.22, 95% CI 1.14–4.34; OR 2.60, 95% CI 1.21–5.57 respectively), but not 3- to 5-year DFS. Subgroup analysis demonstrated no significant OS difference between lobectomy and MWA, but there were significantly better 1- and 2-year OS with sublobar resection (wedge resection or segmentectomy) versus RFA (OR 2.85, 95% CI 1.33–6.10; OR 4.54, 95% CI 2.51–8.21, respectively). In the two studies which only included patients with stage 1A NSCLC, pooled outcomes demonstrated no significant differences in 1- to 3-year OS or DFS between surgery versus ablation.
Conclusion
Surgical resection of stage 1 NSCLC remains the optimal choice. However, for non-surgical patients with stage 1A, ablation offers promising DFS, CSS, and OS. Future prospective randomized controlled trials are warranted.
Key Points
• Surgical resection of stage 1 NSCLC remains the optimal choice.
• In patients with stage 1A NSCLC who are not surgical candidates, CT-guided microwave or radiofrequency ablation may be an alternative which offers promising disease-free survival and overall survival.
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Abbreviations
- CI:
-
Confidence interval
- CSS:
-
Cancer-specific survival
- CT:
-
Computed tomography
- DFS:
-
Disease-free survival
- MWA:
-
Microwave ablation
- NSCLC:
-
Non-small cell lung cancer
- ORs:
-
Odds ratios
- OS:
-
Overall survival
- PET:
-
Positron emission tomography
- RFA:
-
Radiofrequency ablation
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The scientific guarantor of this publication is Dr Ya Ruth Huo.
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One of the authors has significant statistical expertise.
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Written informed consent was not required for this study because no human patients were directly involved in this systematic review and meta-analysis.
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Some study subjects or cohorts have been previously reported in published papers. This systematic review and meta-analysis pools the studies together.
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Level of evidence: Level 1
Michael Vinchill Chan and Ya Ruth Huo are Equal first co-authors
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LOS, length of stay; NR, not reported
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Chan, M.V., Huo, Y.R., Cao, C. et al. Survival outcomes for surgical resection versus CT-guided percutaneous ablation for stage I non-small cell lung cancer (NSCLC): a systematic review and meta-analysis. Eur Radiol 31, 5421–5433 (2021). https://doi.org/10.1007/s00330-020-07634-7
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DOI: https://doi.org/10.1007/s00330-020-07634-7