Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI.
J Thorac Cardiovasc Surg. 2020 Nov;160(5):1350-1357.e11. doi: 10.1016/j.jtcvs.2019.11.132. Epub 2019 Dec 26.
To compare the overall survival (OS) outcomes of sublobar resection (SLR) with stereotactic body radiation therapy (SBRT) or ablation for patients with early stage non-small cell lung cancer (NSCLC).
Patients with clinical stage I (T1-T2aN0M0) NSCLC from 2004 to 2014 who were treated with SLR, SBRT, or ablation as the sole treatment were identified from the National Cancer Database. OS was estimated using the Kaplan-Meier method and evaluated by log-rank test, univariate and multivariate Cox proportional hazard regression, and propensity score-matched analysis. Relative survival analyses compared with age- and sex-matched US population were performed.
A total of 53,973 patients were identified. The 1-, 2-, 3-, and 5-year relative survival rates were 96%, 90%, 84%, and 71% for SLR (n = 30,451); 93%, 78%, 65%, and 46% for SBRT (n = 22,134); and 90%, 73%, 58%, and 37% for ablation (n = 1388). Propensity score matching resulted in 9967 patients in the SBRT group versus 9967 in the SLR group and 1062 patients in the ablation group versus 1984 in the SLR group. After matching, both SBRT (hazard ratio, 1.559; 95% confidence interval, 1.497-1.623; P < .001) and ablation (hazard ratio, 1.906; 95% confidence interval, 1.730-2.101; P < .001) were associated with shorter OS when compared with SLR. These results persisted in patients with tumor size ≤2 cm.
Preliminary results suggest SLR may be associated with longer OS in patients with early-stage NSCLC compared with SBRT or ablation. Future prospective, randomized, controlled clinical trials comparing these treatments are needed to confirm these results.
比较亚肺叶切除术（SLR）与立体定向体放射治疗（SBRT）或消融治疗用于早期非小细胞肺癌（NSCLC）患者的总生存期（OS）结果。
从国家癌症数据库中确定了 2004 年至 2014 年期间接受 SLR、SBRT 或消融作为单一治疗的临床 I 期（T1-T2aN0M0）NSCLC 患者。使用 Kaplan-Meier 方法估计 OS，并通过对数秩检验、单因素和多因素 Cox 比例风险回归以及倾向评分匹配分析进行评估。与年龄和性别匹配的美国人群进行相对生存分析。
共确定了 53973 名患者。SLR（n=30451）的 1、2、3 和 5 年相对生存率分别为 96%、90%、84%和 71%；SBRT（n=22134）分别为 93%、78%、65%和 46%；消融（n=1388）分别为 90%、73%、58%和 37%。倾向评分匹配后，SBRT 组有 9967 例患者与 SLR 组匹配，消融组有 1062 例患者与 SLR 组匹配。匹配后，与 SLR 相比，SBRT（风险比，1.559；95%置信区间，1.497-1.623；P<0.001）和消融（风险比，1.906；95%置信区间，1.730-2.101；P<0.001）均与较短的 OS 相关。这些结果在肿瘤大小≤2cm 的患者中仍然存在。
初步结果表明，与 SBRT 或消融相比，SLR 可能与早期 NSCLC 患者的 OS 延长相关。需要未来的前瞻性、随机、对照临床试验来证实这些结果。
