Introduction: Despite clear guideline recommendations, surgery is not consistently carried out as part of multimodal therapy in stage I small cell lung cancer (SCLC) patients. The role of surgery in stages II and III is even more controversial. In the absence of current randomized control trials (RCT), we performed a meta-analysis comparing surgery versus non-surgical treatment in stage I to III SCLC patients. Methods: A systematic review of the literature was conducted on 1 July 2023, focusing on studies pertaining to the impact of surgery on small cell lung cancer (SCLC). These studies were evaluated using the ROBINS-I tool. Statistical analyses, including I² tests, Q-statistics, DerSimonian-Laird tests, and Egger regression, were performed to assess the data. In addition, 5-year survival rates were analyzed. The meta-analysis was conducted according to PRISMA standards. Results: Among the 6826 records identified, 10 original studies encompassing a collective cohort of 95,323 patients were incorporated into this meta-analysis. Heterogeneity was observed across the included studies, with no discernible indication of publication bias. Analysis of patient characteristics revealed no significant differences between the two groups (p-value > 0.05). The 5-year survival rates in a combined analysis of patients in stages I–III were 39.6 ± 15.3% for the ‘surgery group’ and 16.7 ± 12.7% for the ‘non-surgery group’ (p-value < 0.0001). SCLC patients in stages II and III treated outside the guideline with surgery had a significantly better 5-year survival compared to non-surgery controls (36.3 ± 20.2% vs. 20.2 ± 17.0%;p-value = 0.043). Conclusions: In the absence of current RCTs, this meta-analysis provides robust suggestions that surgery might significantly improve survival in all SCLC stages. Non-surgical therapy could lead to a shortening of life. The feasibility of surgery in non-metastatic SCLC should always be evaluated as part of a multimodal treatment.
引言：尽管指南已有明确推荐，手术在Ⅰ期小细胞肺癌（SCLC）患者的多模式治疗中并未得到普遍应用。手术在Ⅱ期和Ⅲ期患者中的作用更具争议性。在当前缺乏随机对照试验（RCT）的情况下，我们开展了一项荟萃分析，比较Ⅰ至Ⅲ期SCLC患者接受手术与非手术治疗的效果差异。 方法：我们于2023年7月1日对相关文献进行了系统性回顾，重点关注手术对小细胞肺癌（SCLC）疗效影响的研究。采用ROBINS-I工具对纳入研究进行质量评估。通过I²检验、Q统计量、DerSimonian-Laird检验及Egger回归等统计方法进行数据分析，并对5年生存率进行重点评估。本荟萃分析严格遵循PRISMA标准实施。 结果：在筛选出的6826条记录中，最终纳入10项原始研究，共涵盖95,323例患者。纳入研究间存在异质性，但未发现明显发表偏倚。患者基线特征分析显示两组间无显著差异（p值>0.05）。Ⅰ-Ⅲ期患者的合并分析显示：手术组5年生存率为39.6±15.3%，非手术组为16.7±12.7%（p值<0.0001）。特别值得注意的是，在指南推荐范围外接受手术治疗的Ⅱ-Ⅲ期SCLC患者，其5年生存率显著优于非手术对照组（36.3±20.2% vs. 20.2±17.0%；p值=0.043）。 结论：在当前缺乏随机对照试验的情况下，本荟萃分析提供了有力证据，表明手术可能显著改善各分期SCLC患者的生存预后。非手术治疗可能导致生存期缩短。对于非转移性SCLC患者，应将手术可行性评估作为多模式治疗方案的重要组成部分。
肿瘤(癌症)患者之家