Skip to main content
SpringerLink
Log in

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

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

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

References

  1. Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108

    Article  Google Scholar 

  2. Postmus P, Kerr KM, Oudkerk M et al (2017) Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28(suppl_4):iv1–iv21

    Article  CAS  Google Scholar 

  3. Keenan RJ, Landreneau RJ, Maley RH Jr et al (2004) Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg 78(1):228–233

    Article  Google Scholar 

  4. Berry MF, Hanna J, Tong BC et al (2009) Risk factors for morbidity after lobectomy for lung cancer in elderly patients. Ann Thorac Surg 88(4):1093–1099

    Article  Google Scholar 

  5. Yang J, Xia Y, Yang Y et al (2014) Risk factors for major adverse events of video-assisted thoracic surgery lobectomy for lung cancer. Int J Med Sci 11(9):863

    Article  Google Scholar 

  6. Donington J, Ferguson M, Mazzone P et al (2012) American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest 142(6):1620–1635

    Article  Google Scholar 

  7. Safi S, Rauch G, op den Winkel J et al (2015) Sublobar resection, radiofrequency ablation or radiotherapy in stage I non-small cell lung cancer. Respiration 89(6):550–557

    Article  Google Scholar 

  8. Wang Y, Liu B, Cao P et al (2018) Comparison between computed tomography-guided percutaneous microwave ablation and thoracoscopic lobectomy for stage I non-small cell lung cancer. Thorac Cancer 9(11):1376–1382

    Article  Google Scholar 

  9. Yao W, Lu M, Fan W et al (2018) Comparison between microwave ablation and lobectomy for stage I non-small cell lung cancer: a propensity score analysis. Int J Hyperthermia 34(8):1329–1336

    Article  Google Scholar 

  10. Kim SR, Han HJ, Park SJ et al (2012) Comparison between surgery and radiofrequency ablation for stage I non-small cell lung cancer. Eur J Radiol 81(2):395–399

    Article  Google Scholar 

  11. Subramanian M, McMurry T, Meyers B et al (2018) Long-term results for clinical stage IA lung cancer: comparing lobectomy and sublobar resection. Ann Thorac Surg 106(2):375–381

    Article  Google Scholar 

  12. Sienel W, Dango S, Kirschbaum A et al (2008) Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections. Eur J Cardiothorac Surg 33(4):728–734

    Article  Google Scholar 

  13. Ginsberg RJ, Rubinstein LV, L.C.S. Group (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg 60(3):615–623

    Article  CAS  Google Scholar 

  14. Solazzo SA, Liu Z, Lobo SM et al (2005) Radiofrequency ablation: importance of background tissue electrical conductivity—an agar phantom and computer modeling study. Radiology 236(2):495–502

    Article  Google Scholar 

  15. Brace CL, Hinshaw JL, Laeseke PF, Sampson LA, Lee FT (2009) Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology 251(3):705–711

    Article  Google Scholar 

  16. Vogl TJ, Eckert R, Naguib NN, Beeres M, Gruber-Rouh T, Nour-Eldin NA (2016) Thermal ablation of colorectal lung metastases: retrospective comparison among laser-induced thermotherapy, radiofrequency ablation, and microwave ablation. AJR Am J Roentgenol 207(6):1340–1349

    Article  Google Scholar 

  17. Moher D, Shamser L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1):1

    Article  Google Scholar 

  18. NHMRC (2000) How to use the evidence: assessment and application of scientific evidence. Canberra, National Health and Medical Research Council.

    Google Scholar 

  19. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  Google Scholar 

  20. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  Google Scholar 

  21. Alexander ES, Machan JT, Ng T, Breen LD, DiPetrillo TA, Dupuy DE (2013) Cost and effectiveness of radiofrequency ablation versus limited surgical resection for stage I non-small-cell lung cancer in elderly patients: is less more? J Vasc Interv Radiol 24(4):476–482

    Article  Google Scholar 

  22. Ambrogi MC, Fanucchi O, Dini P (2015) Wedge resection and radiofrequency ablation for stage I nonsmall cell lung cancer. Eur Respir J 45(4):1089–1097

    Article  Google Scholar 

  23. Kwan SW, Mortell KE, Talenfeld AD, Brunner MC (2014) Thermal ablation matches sublobar resection outcomes in older patients with early-stage non-small cell lung cancer. J Vasc Interv Radiol 25(1):1–9.e1

    Article  Google Scholar 

  24. Zemlyak A, Moore WH, Bilfinger TV (2010) Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer. J Am Coll Surg 211(1):68–72

    Article  Google Scholar 

  25. Yasufuku K, Nakajima T, Motoori K et al (2006) Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest 130(3):710–718

    Article  Google Scholar 

  26. Cackler S, Abbas G (2009) RFA is an effective alternative to lobectomy for lung cancer. JAAPA 22(1):25–28

    Article  Google Scholar 

  27. Vogl TJ, Naguib NNN, Gruber-Fouh T et al (2011) Microwave ablation therapy: clinical utility in treatment of pulmonary metastases. Radiology 261(2):643–651

    Article  Google Scholar 

  28. Ito N, Nakatsuka S, Inoue M et al (2012) Computed tomographic appearance of lung tumors treated with percutaneous cryoablation. J Vasc Interv Radiol 23(8):1043–1052

    Article  Google Scholar 

  29. Deandreis D, Leboulleux S, Dromain C et al (2011) Role of FDG PET/CT and chest CT in the follow-up of lung lesions treated with radiofrequency ablation. Radiology 258(1):270–276

    Article  Google Scholar 

  30. Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT (2017) The eighth edition lung cancer stage classification. Chest 151(1):193–203

    Article  Google Scholar 

  31. Lanuti M, Sharma A, Willers H, Digumarthy SR, Mathisen DJ, Shepart JA (2012) Radiofrequency ablation for stage I non-small cell lung cancer: management of locoregional recurrence. Ann Thorac Surg 93(3):921–927 discussion 927-88

    Article  Google Scholar 

  32. Kashima M, Yamakado K, Takaki H et al (2011) Complications after 1000 lung radiofrequency ablation sessions in 420 patients: a single center’s experiences. AJR Am J Roentgenol 197(4):W576–W580

    Article  Google Scholar 

  33. Cao C, Wang D, Chung C et al (2019) A systematic review and meta-analysis of stereotactic body radiation therapy versus surgery for patients with non–small cell lung cancer. J Thorac Cardiovasc Surg 157(1):362–373. e8

    Article  Google Scholar 

  34. Uhlig J, Ludwig JM, Goldberg SB, Chiang A, Blasberg JD, Kim HS (2018) Survival rates after thermal ablation versus stereotactic radiation therapy for stage 1 non-small cell lung cancer: a National Cancer Database study. Radiology 289(3):862–870

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Concord Repatriation General Hospital, Concord, NSW, 2137, Australia

    Michael Vinchill Chan, Ya Ruth Huo & Lloyd Ridley

  2. Concord Hospital Clinical Medical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia

    Michael Vinchill Chan & Lloyd Ridley

  3. Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Christopher Cao

  4. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia

    Christopher Cao

Authors
  1. Michael Vinchill Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ya Ruth Huo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lloyd Ridley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ya Ruth Huo.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr Ya Ruth Huo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because no human patients were directly involved in this systematic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because this was a systematic review and meta-analysis.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in published papers. This systematic review and meta-analysis pools the studies together.

Methodology

• Systematic review and meta-analysis

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: Level 1

Michael Vinchill Chan and Ya Ruth Huo are Equal first co-authors

Supplementary Information

ESM 1

(DOCX 17 kb)

LOS, length of stay; NR, not reported

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-07634-7

Keywords

Search

Navigation