European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Benefit of adjuvant chemotherapy for resected stage I lung cancer with spread through air spaces: a systematic review and meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Du Haoxuan, Li Xiang, Wang Yaqi, Wang Quanne, Tao Ye, Cui Xinrun, Wen Zengjin, Yan Shi, Wu Nan
Аннотация
BACKGROUND: Spread through air spaces (STAS) has been proved to be an independent risk factor for poor prognosis in patients with stage I lung cancer. Evidence regarding the application of adjuvant chemotherapy (ACT) in STAS-positive patients with stage I lung cancer remains insufficient. This study aims to elucidate the significance and indication of ACT in patients with stage I lung cancer with STAS.
METHODS: Three major electronic databases were searched to identify relevant studies published up to June 26, 2024. Subsequently, the retrieved studies were screened according to predetermined inclusion and exclusion criteria. Hazard ratio (HR) and corresponding 95 % confidence interval (CI) were computed, and sensitivity analysis was performed to evaluate the sources of heterogeneity.
RESULTS: Five studies involving 2899 patients were included in the meta-analysis. ACT could effectively prolong disease-free survival (DFS; HR 0.69 [95 % CI 0.48-0.99]; P = 0.044) and overall survival (OS; HR 0.61 [95 % CI 0.47-0.79]; P < 0.001) in patients with stage I lung cancer with STAS. Even patients who have undergone lobectomy could benefit from ACT (DFS; HR 0.61 [95 % CI 0.45-0.82]; P = 0.001| OS; HR 0.60 [95 % CI 0.42-0.85]; P = 0.005). Moreover, ACT significantly extended DFS in STAS-positive stage IB cases (HR 0.55, 95 % CI 0.38-0.79; P = 0.001), rather than stage IA cases (HR 0.72, 95 %CI 0.42-1.25; P = 0.246).
CONCLUSION: ACT might be recommended to STAS-positive stage IB lung cancer patients, even if they have undergone radical lobectomy. Randomized controlled trials (RCTs), however, are required to confirm these findings.
METHODS: Three major electronic databases were searched to identify relevant studies published up to June 26, 2024. Subsequently, the retrieved studies were screened according to predetermined inclusion and exclusion criteria. Hazard ratio (HR) and corresponding 95 % confidence interval (CI) were computed, and sensitivity analysis was performed to evaluate the sources of heterogeneity.
RESULTS: Five studies involving 2899 patients were included in the meta-analysis. ACT could effectively prolong disease-free survival (DFS; HR 0.69 [95 % CI 0.48-0.99]; P = 0.044) and overall survival (OS; HR 0.61 [95 % CI 0.47-0.79]; P < 0.001) in patients with stage I lung cancer with STAS. Even patients who have undergone lobectomy could benefit from ACT (DFS; HR 0.61 [95 % CI 0.45-0.82]; P = 0.001| OS; HR 0.60 [95 % CI 0.42-0.85]; P = 0.005). Moreover, ACT significantly extended DFS in STAS-positive stage IB cases (HR 0.55, 95 % CI 0.38-0.79; P = 0.001), rather than stage IA cases (HR 0.72, 95 %CI 0.42-1.25; P = 0.246).
CONCLUSION: ACT might be recommended to STAS-positive stage IB lung cancer patients, even if they have undergone radical lobectomy. Randomized controlled trials (RCTs), however, are required to confirm these findings.