Pleural recurrence after transthoracic needle lung biopsy in stage i lung cancer: A systematic review and individual patient-level meta-analysis

Hyunsook Hong, Seokyung Hahn, Haruhisa Matsuguma, Masayoshi Inoue, Yasushi Shintani, Osamu Honda, Yotaro Izumi, Keisuke Asakura, Hisao Asamura, Tetsuya Isaka, Kyungjong Lee, Yong Soo Choi, Young Tae Kim, Chang Min Park, Jin Mo Goo, Soon Ho Yoon

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)582-590
Number of pages9
JournalThorax
Volume76
Issue number6
DOIs
Publication statusPublished - 2021 Jun 1

Keywords

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

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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