Meta-analysis of comparing part-solid and pure-solid tumors in patients with clinical stage IA non-small-cell lung cancer in the eighth edition TNM classification
Received 30 November 2018
Accepted for publication 25 February 2019
Published 10 April 2019 Volume 2019:11 Pages 2951—2961
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 2
Editor who approved publication: Professor Nakshatri
Tian Jiang, Ming Li, Miao Lin, Mengnan Zhao, Cheng Zhan, Mingxiang Feng
Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People’s Republic of China
Objective: The aim of the study was to compare the prognoses between part-solid and pure-solid tumors for clinical stage IA non-small-cell lung cancer (NSCLC) patients in the eighth edition TNM classification.
Methods: We searched the literature in PubMed and Web of Science for all eligible articles published before November 31, 2018. The pooled data included overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). The hazard ratio (HR) of OS (pure-solid/part-solid) was used as the measure of differential effects. Pure-solid or part-solid tumors in all studies included were matched according to the solid component size or according to the eighth edition TNM classification.
Results: Seven studies including 2,037 patients with c-stage IA NSCLC were pooled in the meta-analysis. Patients with pure-solid tumors had significantly poorer OS (HR 1.69, 95% CI 1.21‒2.35, P=0.002), DFS (HR 1.27, 95% CI 1.07‒1.51, P=0.006) and RFS (HR 1.74, 95% CI 1.08‒2.80, P=0.020). In subgroup analyses, when the meta-analysis was limited to T1a-1b (≤2 cm) lung cancer, the prognosis for pure-solid tumors was inferior to that for part-solid tumors regarding both OS and RFS. In adenocarcinoma subgroup, there was no difference between the two groups in terms of OS and RFS, but we detected a meaningful difference in DFS.
Conclusion: Part-solid tumors may have a better prognosis than pure-solid tumors in clinical stage IA patients according to the eighth edition TNM classification, and similar results were found for the T1a-1b (≤2 cm) subgroup. There were no substantial differences in OS and RFS between two groups in lung adenocarcinoma. However, we detected a meaningful difference in DFS, which might also suggest a superior prognosis for part-solid tumors. We propose that the part-solid and pure-solid tumors in the same T component category be considered separately.
Keywords: part-solid, pure-solid, stage IA, adenocarcinoma, lung cancer, meta-analysis
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