Till Brian M, Mack Shale, Whitehorn Gregory, Rahman Uzma, Thosani Darshak, Grenda Tyler, Evans Nathaniel R, Okusanya Olugbenga
Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa.
J Thorac Cardiovasc Surg. 2023 Feb;165(2):471-479. doi: 10.1016/j.jtcvs.2022.07.030. Epub 2022 Aug 6.
Stereotactic body radiation therapy (SBRT) is increasingly used to treat non-small cell lung cancer. The purpose of this study is to analyze relationships between facility SBRT utilization and surgical patient selection and survival after surgery.
Data on patients with TI/T2N0M0 lesions and treatment facility characteristics were abstracted from the National Cancer Database, 2008 to 2017. Facilities were stratified using an SBRT/surgery ratio previously associated with short-term survival benefit for patients treated surgically, and by a previously identified surgical volume threshold. Multiple regression analyses, Cox proportional-hazard regressions, and Kaplan-Meier log rank test were employed.
In total, 182,610 patients were included. Proportion of high SBRT:surgery ratio (≥17%) facilities increased from 118 (11.5%) to 558 (48.4%) over the study period. Patients undergoing surgery at high-SBRT facilities had comparable comorbidity scores and tumor sizes to those at low-SBRT facilities, and nonclinically significant differences in age, race, and insurance status. Among low-volume surgical facilities, treatment at a high SBRT-using facility was associated with decreased 30-day mortality (1.8% vs 1.4%, P < .001) and 90-day mortality (3.3% vs 2.6%, P < .001). At high-volume surgical facilities, no difference was observed. At 5 years, a survival advantage was identified for patients undergoing resection at facilities with high surgical volumes (hazard ratio, 0.91; confidence interval, 0.90-0.93 P < .001) but not at high SBRT-utilizing facilities.
Differences in short-term survival following resection at facilities with high-SBRT utilization may be attributable to low surgical volume facilities. Patients treated at high volume surgical facilities do not demonstrate differences in short-term or long-term survival based on facility SBRT utilization.
立体定向体部放射治疗（SBRT）越来越多地用于治疗非小细胞肺癌。本研究的目的是分析机构SBRT利用率与手术患者选择及术后生存之间的关系。
从2008年至2017年的国家癌症数据库中提取TI/T2N0M0病变患者的数据和治疗机构特征。根据先前与手术治疗患者短期生存获益相关的SBRT/手术比例以及先前确定的手术量阈值对机构进行分层。采用多元回归分析、Cox比例风险回归和Kaplan-Meier对数秩检验。
共纳入182,610例患者。在研究期间，高SBRT:手术比例（≥17%）的机构比例从118家（11.5%）增加到558家（48.4%）。在高SBRT机构接受手术的患者与低SBRT机构的患者具有相似的合并症评分和肿瘤大小，在年龄、种族和保险状况方面无临床显著差异。在低手术量的外科机构中，在使用高SBRT的机构接受治疗与30天死亡率降低（1.8%对1.4%，P <.001）和90天死亡率降低（3.3%对2.6%，P <.001）相关。在高手术量的外科机构中，未观察到差异。在5年时，在高手术量机构接受切除的患者具有生存优势（风险比，0.91；置信区间，0.90 - 0.93，P <.001），但在高SBRT使用机构中未观察到。
高SBRT利用率机构切除术后短期生存的差异可能归因于低手术量机构。在高手术量外科机构接受治疗的患者，基于机构SBRT利用率，在短期或长期生存方面未显示出差异。
