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Original research
Pleural recurrence after transthoracic needle lung biopsy in stage I lung cancer: a systematic review and individual patient-level meta-analysis
  1. Hyunsook Hong1,
  2. Seokyung Hahn2,
  3. Haruhisa Matsuguma3,
  4. Masayoshi Inoue4,
  5. Yasushi Shintani5,
  6. Osamu Honda6,
  7. Yotaro Izumi7,
  8. Keisuke Asakura8,
  9. Hisao Asamura8,
  10. Tetsuya Isaka9,
  11. Kyungjong Lee10,
  12. Yong Soo Choi11,
  13. Young Tae Kim12,
  14. Chang Min Park13,
  15. Jin Mo Goo13,
  16. Soon Ho Yoon13
  1. 1 Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
  2. 2 Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
  3. 3 Divisions of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
  4. 4 Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  5. 5 Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita-City, Osaka, Japan
  6. 6 Department of Radiology, Kansai Medical University, Moriguchi, Osaka, Japan
  7. 7 Department of General Thoracic Surgery, Saitama Medical University, Saitama Medical Center, Kawagoe, Saitama, Japan
  8. 8 Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
  9. 9 Department of Respiratory Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
  10. 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  11. 11 Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  12. 12 Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
  13. 13 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Dr Soon Ho Yoon, Department of Radiology, Seoul National University Hospital, Seoul 03080, Republic of Korea; yshoka{at}gmail.com

Abstract

Introduction Conflicting results exist regarding whether preoperative transthoracic biopsy increases the risk of pleural recurrence in early lung cancer. We conducted a systematic, patient-level meta-analysis to evaluate the risk of pleural recurrence in stage I lung cancer after percutaneous transthoracic lung biopsy.

Methods A systematic search of OVID-MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed through October 2018. Eligible studies were original articles on the risk of pleural recurrence in stage I lung cancer after transthoracic biopsy. We contacted the corresponding authors of eligible studies to obtain individual patient-level data. We used the Fine-Gray model for time to recurrence and lung cancer-specific survival and a Cox proportional hazards model for overall survival.

Results We analysed 2394 individual patient data from 6 out of 10 eligible studies. Compared with other diagnostic procedures, transthoracic biopsy was associated with a higher risk for ipsilateral pleural recurrence, which manifested solely (subdistribution HR (sHR), 2.58; 95% CI 1.15 to 5.78) and concomitantly with other metastases (sHR 1.99; 95% CI 1.14 to 3.48). In the analysis of secondary outcomes considering a significant interaction between diagnostic procedures and age groups, reductions of time to recurrence (sHR, 2.01; 95% CI 1.11 to 3.64), lung cancer-specific survival (sHR 2.53; 95% CI 1.06 to 6.05) and overall survival (HR 2.08; 95% CI 1.12 to 3.87) were observed in patients younger than 55 years, whereas such associations were not observed in other age groups.

Discussion Preoperative transthoracic lung biopsy was associated with increased pleural recurrence in stage I lung cancer and reduced survival in patients younger than 55 years.

  • lung cancer
  • pleural disease
  • non-small cell lung cancer

Data availability statement

Data are available on reasonable request to the corresponding author.

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Data availability statement

Data are available on reasonable request to the corresponding author.

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Footnotes

  • Contributors HH, SH and SHY conceived the study concept and design. HH and SHY undertook the literature searches and study selection. HM, MI, YS, OH, YI, KA, HA, TI and K-JL contributed to collecting individual participant data. HH, SHY cleaned and checked data quality. HH, SH and SHY conducted the meta-analyses. All authors contributed to the interpretation of data. HH, SH and SHY wrote the first draft of the manuscript. All authors contributed to the critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SHY works a chief medical officer in MEDICALIP since November 2020 outside this work. CMP received a research grant from Lunit outside this work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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