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Comparison among stereotactic body radiation therapy, lobectomy, segmentectomy, and wedge resection for clinical stage I non-small cell lung cancer: a network meta-analysis

Year: 2025
Type: article
Abstract: Background: Lung resections and stereotactic body radiation therapy (SBRT) are primary treatments for clinical stage I non-small cell lung cancer (NSCLC). The aim of this network meta-analysis is to compare the differences in effectiveness between SBRT and specific lung resections, including lobectomy, segmentectomy, and wedge resection for clinical stage I NSCLC. Methods: PubMed, EMBASE, Cochrane Library, and the ClinicalTrials.gov registry were searched. Random-effects model was conducted to assess differences in survival outcomes and treatment-related complication incidence between SBRT and three specific lung resections (lobectomy, segmentectomy, wedge resection). Subgroup analyses were performed according to clinical stages, regions, and publication years. Results: A total of 30 studies were enrolled for network meta-analysis. All three lung resections demonstrated superior overall survival (OS) compared with SBRT [lobectomy: hazard ratio (HR) 0.65, 95% confidence interval: 0.53-0.79; segmentectomy: HR 0.64, 95% confidence interval: 0.50-0.82); wedge resection: HR 0.72, 95% confidence interval: 0.55-0.93]. The recurrence-free survival (RFS) of patients in lobectomy and segmentectomy groups was significantly better than that of patients in the SBRT group, with no significant difference between the wedge resection and SBRT groups. Patients with clinical stage IA NSCLC showed no significant difference in OS between SBRT and three lung resections (lobectomy: HR 0.99, 95% confidence interval: 0.85-1.16; segmentectomy: HR 0.98, 95% confidence interval: 0.83-1.16; wedge resection: HR 1.71, 95% confidence interval: 0.91-3.26). Conclusions: For clinical stage I NSCLC patients, lobectomy and segmentectomy are superior to SBRT. Wedge resection is associated with similar RFS but better OS to SBRT. In clinical stage IA NSCLC, SBRT may provide comparable OS to lung resections.
DOI: 10.21037/jtd-2025-1568
Authors: Junjie Zhang, Siyu Zeng, Zhiqiang Deng, Jiaming He, Ludan Zhang, Wenlong Hu, Yuyang Mao, Ailing Zhong, Jing Chen, Haining Zhou, Kaidi Li, Haoji Yan
Institutions: Sichuan University, West China Hospital of Sichuan University, Central South University, Third Xiangya Hospital, Xiangya Hospital Central South University, North Sichuan Medical University, Juntendo University, Juntendo University Hospital
Language: English
Field: Medicine
Open Access status: diamond
OpenAlex ID: W7117652677
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