Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Diagnostic and Interventional Radiology, University Medical Center, Goettingen, Germany.
Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
J Vasc Interv Radiol. 2021 Jul;32(7):1022-1028.e4. doi: 10.1016/j.jvir.2021.02.025. Epub 2021 Mar 31.
To assess whether the effectiveness of thermal ablation (TA) and stereotactic body radiotherapy (SBRT) as initial treatments for stage I lung cancer varies depending on the histological subtype.
The 2004-2016 National Cancer Database was queried for patients with American Joint Committee on Cancer stage I lung cancer treated with TA or SBRT. Patients <18 years, those treated with surgery or chemotherapy, or those with unknown survival and follow-up were excluded. TA and SBRT patients were 1:5 propensity score matched separately for each histological subtype to adjust for confounders. Overall survival (OS) was assessed using Cox models.
A total of 28,425 patients were included (SBRT, n = 27,478; TA, n = 947). TA was more likely to be used in Caucasian patients, those with more comorbidities and smaller neuroendocrine tumors (NETs) of the lower lobe, and those whose treatment had taken place in the northeastern United States. After propensity score matching, a cohort with 4,085 SBRT and 817 TA patients with balanced confounders was obtained. In this cohort, OS for TA and SBRT was comparable (hazard ratio = 1.07; 95% confidence interval,0.98-1.18; P = .13), although it varied by histological subtypes: higher OS for TA was observed in patients with non-small cell NETs (vs SBRT hazard ratio = 0.48; 95% confidence interval, 0.24-0.95; P = .04). No significant OS differences between TA and SBRT were noted for adenocarcinomas, squamous cell carcinomas, small cell carcinomas, and non-neuroendocrine large cell carcinomas (each, P > .1).
OS following TA and SBRT for stage I lung cancer is comparable for most histological subtypes, except that OS is longer after TA in non-small cell NETs.
评估热消融（TA）和立体定向体放射治疗（SBRT）作为Ⅰ期肺癌初始治疗的效果是否因组织学亚型而异。
从 2004 年至 2016 年，美国国家癌症数据库（National Cancer Database）对接受 TA 或 SBRT 治疗的Ⅰ期肺癌美国癌症联合委员会（American Joint Committee on Cancer）患者进行了查询。排除年龄<18 岁、接受手术或化疗治疗以及生存和随访情况未知的患者。分别对 TA 和 SBRT 患者进行 1:5 的倾向评分匹配，以调整混杂因素。使用 Cox 模型评估总生存期（OS）。
共纳入 28425 例患者（SBRT，n=27478；TA，n=947）。TA 更可能用于白人患者、合并症更多的患者以及下叶较小的神经内分泌肿瘤（NETs）患者，以及在美国东北部接受治疗的患者。在进行倾向评分匹配后，获得了一个具有 4085 例 SBRT 和 817 例 TA 患者且混杂因素均衡的队列。在该队列中，TA 和 SBRT 的 OS 相当（风险比=1.07；95%置信区间，0.98-1.18；P=0.13），尽管其因组织学亚型而异：非小细胞 NET 患者中 TA 的 OS 更高（与 SBRT 的风险比=0.48；95%置信区间，0.24-0.95；P=0.04）。对于腺癌、鳞状细胞癌、小细胞癌和非神经内分泌大细胞癌，TA 和 SBRT 之间的 OS 无显著差异（均 P>.1）。
Ⅰ期肺癌接受 TA 和 SBRT 治疗后的 OS 对于大多数组织学亚型是相当的，除了非小细胞 NET 患者接受 TA 治疗后的 OS 更长。
