Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, 357115, Seattle, WA 98195.
Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio.
J Vasc Interv Radiol. 2014 Jan;25(1):1-9.e1. doi: 10.1016/j.jvir.2013.10.018.
To compare survival outcomes of sublobar resection and thermal ablation for early-stage non-small cell lung cancer (NSCLC) in older patients.
SEER-Medicare linked data for patients with a diagnosis of lung cancer from 2007-2009 were used. Patients ≥ 65 years old with stage IA or IB NSCLC who were treated with sublobar resection or thermal ablation were identified. Primary outcome was overall survival (OS), and secondary outcome was lung cancer-specific survival (LCSS). Demographic and clinical variables were compared. Unadjusted OS and LCSS curves were estimated using the Kaplan-Meier method, and multivariate analysis was performed using the Cox model. OS and LCSS curves for propensity score matched groups were also compared.
The final unmatched study population comprised 1,897 patients. Patients who underwent sublobar resection were significantly younger (P = .006) and significantly less likely to have a comorbidity index > 1 (P = .036), a diagnosis of chronic obstructive pulmonary disease (P = .017), or adjuvant radiation therapy (P < .0001) compared with patients treated with thermal ablation. Unadjusted survival curves of unmatched groups demonstrated significantly better OS (P = .028) and LCSS (P = .0006) in the resection group. Multivariate Cox model adjusting for demographic and clinical variables found no significant difference in OS between the treatment groups (P = .555); a difference in LCSS (hazard ratio = 1.185, P = .026) persisted. Survival curves for matched groups found no significant difference in OS (P = .695) or LCSS (P = .819) between treatment groups.
After controlling for selection bias, this study found no difference in OS between patients treated with sublobar resection and thermal ablation.
比较亚肺叶切除术和热消融术治疗老年早期非小细胞肺癌（NSCLC）的生存结果。
利用 2007-2009 年 SEER-Medicare 链接数据，筛选出诊断为肺癌且年龄≥65 岁、IA 期或 IB 期 NSCLC 患者，这些患者接受了亚肺叶切除术或热消融术治疗。主要结局是总生存期（OS），次要结局是肺癌特异性生存期（LCSS）。比较了人口统计学和临床变量。使用 Kaplan-Meier 法估计未调整的 OS 和 LCSS 曲线，并使用 Cox 模型进行多变量分析。还比较了倾向评分匹配组的 OS 和 LCSS 曲线。
最终的未匹配研究人群包括 1897 例患者。与接受热消融术治疗的患者相比，接受亚肺叶切除术的患者年龄明显较小（P =.006），且合并症指数>1（P =.036）、慢性阻塞性肺疾病（P =.017）或辅助放疗（P <.0001）的可能性明显较低。未调整的匹配组生存曲线显示，切除术组的 OS（P =.028）和 LCSS（P =.0006）显著更好。多变量 Cox 模型调整了人口统计学和临床变量后，发现两组之间的 OS 无显著差异（P =.555）；LCSS 仍存在差异（风险比=1.185，P =.026）。匹配组的生存曲线发现，两组之间的 OS（P =.695）或 LCSS（P =.819）均无显著差异。
在控制选择偏倚后，本研究发现亚肺叶切除术和热消融术治疗患者的 OS 无差异。
