Sublobar resection, stereotactic body radiotherapy, and thermal ablation for early-stage non-small cell lung cancer: a systematic review and meta-analysis

INTRODUCTION: For patients with early-stage non-small cell lung cancer (NSCLC) who are unable to tolerate lobectomy, alternative locoregional treatments, including sublobar resection (SLR), stereotactic body radiation therapy (SBRT), or image-guided thermal ablation (IGTA) are available, yet their relative risks and benefits remain uncertain. This systematic review and meta-analysis aims to synthesize existing evidence and compare the survival outcomes of these modalities in early-stage NSCLC. METHODS: A systematic search was conducted through MEDLINE (PubMed), Embase, and CENTRAL on April 20, 2026. Comparative analyses were restricted to propensity score-matched (PSM) studies reporting hazard ratios (HRs) for overall survival (OS) and cancer-specific survival (CSS) in pathologically confirmed early-stage NSCLC. Single-arm pooled survival analyses were performed using reconstructed individual patient data to estimate time-to-event outcomes. Risk of bias was assessed using ROBINS-I for comparative analysis and the JBI checklist for single-arm analyses. RESULTS: Seven PSM studies comparing SBRT and SLR were included in the comparative analysis. SLR was associated with improved OS compared with SBRT (HR 1.51; 95% CI: 1.18-1.93), while CSS did not differ significantly (HR 1.08; 95% CI: 0.48-2.45). Sixteen studies were included in the single-arm analyses. Pooled 3-year OS estimates were 80% (95% CI: 75-86%) for SLR, 64% (95% CI: 56-73%) for SBRT, and 64% (95% CI: 48-86%) for IGTA. Corresponding pooled 3-year CSS estimates were 88% (95% CI: 84-92%), 84% (95% CI: 82-87%), and 76% (95% CI: 50-100%), respectively. CONCLUSIONS: SLR was associated with improved OS, although CSS did not differ significantly between the modalities. SBRT and IGTA represent acceptable alternatives in patients unsuitable for surgery. Treatment selection should be individualized through multidisciplinary assessment.