Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, United States.
Lung Cancer. 2013 Oct;82(1):90-4. doi: 10.1016/j.lungcan.2013.06.021. Epub 2013 Jul 31.
Outcomes following surgery are better than following radiation therapy (RT), for stage I NSCLC. Whether this is due to selection of healthier patients for surgery is unclear. This study was undertaken to compare outcomes between surgical patients and patients who were surgical candidates but did not receive surgery.
Data of patients with stage I NSCLC between 1988 and 2007, included in the SEER database were analyzed. Overall survival (OS) was examined by treatment type (surgery only, radiation only, surgery and radiation, and no treatment). OS was compared between RT patients who refused surgery and those not fit for surgery. Cox proportional hazards model was used to compare outcomes by treatment type.
Data from 8579 patients with stage I NSCLC during 1988-2007 were analyzed. Use of RT alone increased during the study period. An increasing proportion of patients with stage I lung cancer chose to have no treatment. On multivariate analysis, OS was better among patients who had surgery. There was a 56% improvement in survival among patients who had surgery compared to fit patients who refused surgery (HR 0.437, 95% CI 0.301-0.632). Patients who refused surgery had a better OS than those who were not fit for surgery (log-rank p = 0.01). Patients who received RT alone or no treatment had a significant improvement in five-year OS during the latter part of the study period (1998-2002 vs. 1988-1992).
In medically fit patients, outcomes following surgery are better than those following conventional radiation. Hence surgery should be chosen over conventional radiation, whenever possible. Outcomes following RT show an improvement over time reflecting improvement in radiation techniques.
对于 I 期非小细胞肺癌，手术治疗的效果优于放射治疗（RT）。这是否是由于手术选择了更健康的患者尚不清楚。本研究旨在比较手术患者与手术候选但未接受手术的患者的结局。
分析了 1988 年至 2007 年间 SEER 数据库中 I 期非小细胞肺癌患者的数据。根据治疗类型（仅手术、仅放疗、手术和放疗、无治疗）检查总生存率（OS）。比较了拒绝手术和不适合手术的 RT 患者的 OS。使用 Cox 比例风险模型比较治疗类型的结果。
分析了 1988-2007 年期间 8579 例 I 期非小细胞肺癌患者的数据。单独使用 RT 的比例在研究期间有所增加。越来越多的 I 期肺癌患者选择不治疗。多变量分析显示，手术患者的 OS 更好。与适合手术但拒绝手术的患者相比，手术患者的生存改善了 56%（HR 0.437，95%CI 0.301-0.632）。拒绝手术的患者比不适合手术的患者的 OS 更好（对数秩检验，p = 0.01）。单独接受 RT 或未接受治疗的患者在研究后期（1998-2002 年与 1988-1992 年）的五年 OS 显著提高。
在适合手术的患者中，手术后的结果优于常规放疗。因此，只要有可能，就应选择手术而不是常规放疗。随着时间的推移，RT 的结果显示出改善，反映了放射技术的改进。
