Yu James B, Soulos Pamela R, Cramer Laura D, Decker Roy H, Kim Anthony W, Gross Cary P
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.
Cancer. 2015 Jul 15;121(14):2341-9. doi: 10.1002/cncr.29359. Epub 2015 Apr 6.
Although surgery is the standard treatment for early-stage non-small cell lung cancer (NSCLC), stereotactic body radiotherapy (SBRT) has been disseminated as an alternative therapy. The comparative mortalities and toxicities of these treatments for patients of different life expectancies are unknown.
The Surveillance, Epidemiology, and End Results-Medicare linked database was used to identify patients who were 67 years old or older and underwent SBRT or surgery for stage I NSCLC from 2007 to 2009. Matched patients were stratified into short life expectancies (<5 years) and long life expectancies (≥5 years). Mortality and complication rates were compared with Poisson regression.
Overall, 367 SBRT patients and 711 surgery patients were matched. Acute toxicity (0-1 month) was lower from SBRT versus surgery (7.9% vs 54.9%, P < .001). At 24 months after treatment, there was no difference (69.7% vs 73.9%, P = .31). The incidence rate ratio (IRR) for toxicity from SBRT versus surgery was 0.74 (95% confidence interval [CI], 0.64-0.87). Overall mortality was lower with SBRT versus surgery at 3 months (2.2% vs 6.1%, P = .005), but by 24 months, overall mortality was higher with SBRT (40.1% vs 22.3%, P < .001). For patients with short life expectancies, there was no difference in lung cancer mortality (IRR, 1.01; 95% CI, 0.40-2.56). However, for patients with long life expectancies, there was greater overall mortality (IRR, 1.49; 95% CI, 1.11-2.01) as well as a trend toward greater lung cancer mortality (IRR, 1.63; 95% CI, 0.95-2.79) with SBRT versus surgery.
SBRT was associated with lower immediate mortality and toxicity in comparison with surgery. However, for patients with long life expectancies, there appears to be a relative benefit from surgery versus SBRT.
虽然手术是早期非小细胞肺癌（NSCLC）的标准治疗方法，但立体定向体部放疗（SBRT）已作为一种替代疗法得到应用。对于不同预期寿命的患者，这些治疗方法的相对死亡率和毒性尚不清楚。
利用监测、流行病学和最终结果 - 医疗保险链接数据库，识别2007年至2009年期间67岁及以上且因I期NSCLC接受SBRT或手术的患者。匹配的患者被分为预期寿命短（<5年）和预期寿命长（≥5年）两组。采用泊松回归比较死亡率和并发症发生率。
总体而言，匹配了367例接受SBRT的患者和711例接受手术的患者。SBRT的急性毒性（0 - 1个月）低于手术（7.9%对54.9%，P <.001）。治疗后24个月，两者无差异（69.7%对73.9%，P =.31）。SBRT与手术相比，毒性的发病率比（IRR）为0.74（95%置信区间[CI]，0.64 - 0.87）。3个月时，SBRT的总体死亡率低于手术（2.2%对6.1%，P =.005），但到24个月时，SBRT的总体死亡率更高（40.1%对22.3%，P <.001）。对于预期寿命短的患者，肺癌死亡率无差异（IRR，1.01；95% CI，0.40 - 2.56）。然而，对于预期寿命长的患者，SBRT与手术相比，总体死亡率更高（IRR，1.49；95% CI，1.11 - 2.01），且肺癌死亡率有升高趋势（IRR，1.63；95% CI，0.95 - 2.79）。
与手术相比，SBRT的即刻死亡率和毒性较低。然而，对于预期寿命长的患者，手术相对于SBRT似乎有相对益处。
