老年I期肺癌患者应选择手术还是立体定向体部放疗？一项倾向评分匹配分析。
Surgery or stereotactic body radiotherapy for elderly stage I lung cancer? A propensity score matching analysis.
作者信息
Miyazaki Takuro, Yamazaki Takuya, Nakamura Daisuke, Sato Shuntaro, Yamasaki Naoya, Tsuchiya Tomoshi, Matsumoto Keitaro, Kamohara Ryotaro, Hatachi Go, Nagayasu Takeshi
机构信息
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
出版信息
Surg Today. 2017 Dec;47(12):1476-1483. doi: 10.1007/s00595-017-1536-4. Epub 2017 Apr 26.
PURPOSE
The aim of this study was to compare the outcomes of surgery and stereotactic body radiotherapy (SBRT) for elderly clinical stage I non-small cell lung cancer (NSCLC) patients.
METHODS
Patients ≥80 years of age with clinical stage I NSCLC between August 2008 and December 2014 were treated either surgery or SBRT. Propensity score matching was performed to reduce bias in various clinicopathological factors.
RESULTS
Surgery was performed in 57 cases and SBRT in 41 cases. In the surgery group, the operations included 34 lobectomies and 23 sublobar resections. In the SBRT group, 27 cases were given 48 Gy in 4 fractions, and 14 were given 60 Gy in 10 fractions. Similar characteristics were identified in age (82 years), gender (male:female ratio 2:1), tumor size (2.2 cm), carcinoembryonic antigen (3.6 ng/ml), Charlson comorbidity index (1), Glasgow prognostic scale (0), and forced expiratory volume in 1 s (1.7 L) after matching. Before matching, the 5-year overall survival (OS) in surgery (68.3%) was significantly better than that in SBRT (47.4%, p = 0.02), and the 5-year disease-specific survival (DSS) (94.1%, 78.2%, p = 0.17) was not significantly different between the groups. The difference in the 5-year OS became non-significant between the matched pairs (57.0%, 49.1%, p = 0.56).
CONCLUSIONS
The outcomes of surgery and SBRT for elderly patients with the early stage NSCLC were roughly the same.
目的
本研究旨在比较手术和立体定向体部放射治疗（SBRT）对老年临床I期非小细胞肺癌（NSCLC）患者的治疗效果。
方法
对2008年8月至2014年12月期间年龄≥80岁的临床I期NSCLC患者进行手术或SBRT治疗。采用倾向评分匹配法以减少各种临床病理因素的偏差。
结果
57例行手术治疗，41例行SBRT治疗。手术组中，34例行肺叶切除术，23例行肺叶以下切除术。SBRT组中，27例给予48 Gy分4次照射，14例给予60 Gy分10次照射。匹配后，两组在年龄（82岁）、性别（男：女比例2：1）、肿瘤大小（2.2 cm）、癌胚抗原（3.6 ng/ml）、Charlson合并症指数（1）、格拉斯哥预后评分（0）和1秒用力呼气量（1.7 L）方面具有相似特征。匹配前，手术组的5年总生存率（OS）（68.3%）显著高于SBRT组（47.4%，p = 0.02），两组间5年疾病特异性生存率（DSS）（94.1%，78.2%，p = 0.17）无显著差异。匹配后两组间5年OS差异无统计学意义（57.0%，49.1%，p = 0.56）。
结论
手术和SBRT治疗老年早期NSCLC患者的效果大致相同。
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