The Analysis Of Surgery Treatment For Early-stage Non-small Cell Lung Cancer

Background Due to the wide application of computed tomography(CT),the detection of ground glass opacity(GGO)is rapidly increasing in clinical practice.For early-stage non-small cell lung cancer(NSCLC),lobectomy has been the standard choice for many years.However,there is mounting evidence show sublobar resection constitutes treatment for the radiographic “early” lung cancer such as a GGO-dominant lesion,which may equivalent survival to lobectomy.Sublobar resection may play an important role in the management of small stage IA NSCLC.MethodsWe explored the research topic from the Web of Science Core Collection for period 2009-2018.Based on Cite Space IV and VOS viewer,we explored distribution of time,journals,countries/ regions,institutions,authors,disciplines,keywords,and burst terms associated with this topic.A meta-analysis was performed of studies examining survival outcomes following sublobar resection in stage I NSCLC patients.Three electronic databases were searched to identify studies that investigated overall survival(OS),cancer-specific survival(CSS),and disease-free survival(DFS)between patients receiving segmentectomy vs.wedge resection.A total of 19 relevant studies published before 31 April 2018 that satisfied the inclusion criteria were included in this meta-analysis.We retrospectively analyzed the data of 230 patients operated on for part-solid GGO from January 2012 to August 2016.Overall survival(OS)and Disease-Free survival(DFS)were evaluated with Kaplan–Meier analysis.Cox proportional hazards model was used to identify the factors associated with DFS.ResultsAccording to an analysis of 3175 papers,the European Journal of Cardio Thoracic Surgery published the most papers and the United States contributed the most publications in this area.Albain KS from Loyola University occupied the highest co-citation score.The burst terms of ‘morbidity’,‘elderly patient’,and ‘classification’were ranked first as research indicators.The 19 studies involved a total of 14197 patients with stage I NSCLC.OS was significantly better after segmentectomy than after wedge resection(HR = 0.82,95% CI0.77-0.88;P < 0.00001).This was also true of CSS(HR 0.71,95% CI 0.64-0.79;P <0.00001)and DFS(HR = 0.73,95% CI 0.54-0.98;P = 0.04).A fixed-model was applied for analysis as there was no significant heterogeneity between the studies.The median follow-up time was 59.13 months.Lobectomy was performed in 98 patients,and sublobar resection in 132 patients(96 segmentectomy,36 wedge resection).There was no significant difference in 5-year OS and 5-year DFS between patients who underwent lobectomy and sublobar resection(96.9% vs.96.2%,P = 0.70;90.82% vs.90.91% P = 0.97).DFS was significantly lower with wedge resection than with segmentectomy and lobectomy(P = 0.025).Multivariate Cox analysis showed the consolidation/tumor(C/T)ratio to be an independent prognostic factor for DFS.Conclusions1.We were able to construct a systematic analysis of studies related to surgical treatment for NSCLC by providing new perspectives and valuable information.The treatment for locally advanced NSCLC and assisted thoracic surgery were terms that appear to have developmental trends.However,further attention and innovation are still needed in this area.2.Survival following lobar resection for stage I NSCLC is significantly better with segmentectomy than with wedge resection.3.Segmentectomy may be a feasible alternative to lobectomy in patients with part-solid GGOs;wedge resection does not provide any additional advantages.The C/T ratio appears to be an independent prognostic factor for DFS in patients undergoing surgery for part-solid GGOs.