Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
Department of Radiation Oncology, Stanford Cancer Center, Stanford, CA.
Clin Lung Cancer. 2021 Sep;22(5):e678-e683. doi: 10.1016/j.cllc.2021.01.003. Epub 2021 Jan 19.
Stereotactic body radiotherapy (SBRT) has been shown to result in excellent disease control rates for early-stage non-small-cell lung cancer (NSCLC). It remains unknown which patients would most benefit from SBRT in treating NSCLC.
We conducted a retrospective analysis of 346 patients treated with SBRT for early-stage NSCLC at 2 institutions (86 patients from City of Hope National Medical Center and 260 patients from The Newport Beach Radiosurgery Center/Hoag Hospital) from February 2010 to July 2019. The primary endpoint was overall survival (OS). The omnibus test of model coefficients was performed to study the associations between clinical factors and OS. Survival analyses were performed by the log-rank test and Cox proportional hazards regression.
Under the univariate analysis, variables associated with a decreased likelihood of death included age < 65 years (P = .040) and being a surgical candidate (P = .010). Multivariate analysis found that surgical candidates still had a significantly decreased likelihood of death compared to nonsurgical candidates (Hazard ratio 0.360, 95% confidence interval 0.153-0.848, P = .019). Median OS was significantly increased for surgical candidates versus nonsurgical candidates (83 vs 53 months, P = .017). The local failure rate was 9.1%, the locoregional failure rate was 12.7%, and the distant failure rate was 10.7%.
Patients who are deemed to be candidates for surgery have improved OS compared to those who are not when treated with SBRT. This raises the question of selection bias in trials comparing surgery with SBRT in NSCLC, as patients who are deemed to be surgical candidates and then go on to undergo surgery may have an inherent OS benefit.
立体定向体放射治疗（SBRT）已被证明可使早期非小细胞肺癌（NSCLC）获得出色的疾病控制率。目前尚不清楚在治疗 NSCLC 时，哪些患者最适合接受 SBRT。
我们对 2 家机构（希望之城国家医疗中心的 86 例患者和新港滩放射外科中心/霍格医院的 260 例患者）的 346 例接受 SBRT 治疗的早期 NSCLC 患者进行了回顾性分析，时间为 2010 年 2 月至 2019 年 7 月。主要终点是总生存期（OS）。进行了模型系数的总体检验，以研究临床因素与 OS 之间的关联。通过对数秩检验和 Cox 比例风险回归进行生存分析。
在单变量分析中，与死亡可能性降低相关的变量包括年龄<65 岁（P=0.040）和手术候选者（P=0.010）。多变量分析发现，与非手术候选者相比，手术候选者的死亡可能性仍然显著降低（危险比 0.360，95%置信区间 0.153-0.848，P=0.019）。与非手术候选者相比，手术候选者的中位 OS 显著提高（83 个月对 53 个月，P=0.017）。局部失败率为 9.1%，局部区域失败率为 12.7%，远处失败率为 10.7%。
与接受 SBRT 治疗的非手术候选者相比，被认为是手术候选者的患者的 OS 得到了改善。这就提出了在 NSCLC 中比较手术与 SBRT 的试验中存在选择偏倚的问题，因为被认为是手术候选者且随后进行手术的患者可能具有固有的 OS 获益。
