手术切除仍然是早期非小细胞肺癌（NSCLC）的主要治疗方法，其中肺叶切除术被认为是标准方法。然而，最近的证据表明，亚肺叶切除术可能是特定患者的替代选择。按照 PRISMA 指南进行了系统评价和荟萃分析。其中包括比较 NSCLC 患者肺叶切除术和亚肺叶切除术的随机对照试验 (RCT) 和倾向评分匹配 (PSM) 队列研究。主要结局是总生存期 (OS)，次要结局包括无病生存期 (DFS)、30 天死亡率和癌症复发率。根据Kaplan-Meier曲线重建个体患者数据（IPD），并进行一阶段和两阶段荟萃分析。共纳入18项研究，涉及6,075名NSCLC患者（3,119名接受肺叶切除术，2,956名接受亚肺叶切除术）。与亚肺叶切除术相比，肺叶切除术的 OS 显着提高（风险比 [HR]：0.78，95% 置信区间 [CI]：0.68-0.89，p < 0.001）。然而，当亚肺叶切除进一步分为肺段切除术和楔形切除术时，肺叶切除术和肺段切除术之间的 OS 没有观察到显着差异（HR：0.92，95%CI：0.75-1.14，p = 0.464），而肺叶切除术与更好的 OS 相关与楔形切除术相比（HR：0.52，95%CI：0.41-0.67，p < 0.001）。肺叶切除术和亚肺叶切除术的 DFS 结果相似（HR：0.98，95%CI：0.84-1.14，p = 0.778）。与亚肺叶切除术相比，肺叶切除术与 NSCLC 患者的总生存期更好相关。然而，当亚肺叶切除细分时，肺段切除术的结果与肺叶切除术相当，而楔形切除术则较差。这些发现支持考虑将肺段切除术作为 IA 期 NSCLC 患者的首选手术选择。版权所有 © 2024 Elsevier B.V. 保留所有权利。

Surgical resection remains the primary treatment for early-stage non-small cell lung cancer (NSCLC), with lobectomy considered the standard approach. However, recent evidence suggests that sublobar resection may be an alternative option for select patients.A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) and propensity-score matched (PSM) cohort studies comparing lobectomy and sublobar resection in NSCLC patients were included. The primary outcome was overall survival (OS), and secondary outcomes included disease-free survival (DFS), 30-day mortality, and cancer recurrence rates. Individual patient data (IPD) were reconstructed from Kaplan-Meier curves, and one-stage and two-stage meta-analyses were performed.A total of 18 studies involving 6,075 NSCLC patients (3,119 undergoing lobectomy, 2,956 undergoing sublobar resection) were included. Lobectomy was associated with significantly better OS compared to sublobar resection (hazard ratio [HR]: 0.78, 95 % confidence interval [CI]: 0.68-0.89, p < 0.001). However, when sublobar resection was further divided into segmentectomy and wedge resection, no significant difference in OS was observed between lobectomy and segmentectomy (HR:0.92, 95 %CI: 0.75-1.14, p = 0.464) whereas lobar resection was associated with better OS compared to wedge resection (HR:0.52, 95 %CI: 0.41-0.67, p < 0.001). DFS outcomes were similar between lobectomy and sublobar resection (HR:0.98, 95 %CI: 0.84-1.14, p = 0.778).Lobectomy is associated with better overall survival compared to sublobar resection in NSCLC patients. However, when sublobar resection is subdivided, segmentectomy shows comparable outcomes to lobectomy, while wedge resection is inferior. These findings support the consideration of segmentectomy as the surgical option of choice for Stage IA NSCLC patients.Copyright © 2024 Elsevier B.V. All rights reserved.