Department of Radiation Oncology, University of Oklahoma Health Sciences Center.
Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center.
Am J Clin Oncol. 2023 Nov 1;46(11):503-511. doi: 10.1097/COC.0000000000001040. Epub 2023 Sep 8.
Stereotactic body radiation therapy (SBRT) for early-stage non-small cell carcinoma of the lung (NSCLC) is increasingly utilized. We sought to assess overall survival (OS) for early-stage NSCLC patients receiving SBRT depending on staging method.
Early-stage NSCLC patients treated with definitive SBRT were identified in the National Cancer Database (NCDB), and OS was determined based on method of staging. Patient, disease, and treatment characteristics were also analyzed.
A total of 12,106 patients were included; 865 (7%) received invasive staging (nodal sampling, NS) and 11,241 (93%) had no nodal sampling (NNS). From this larger dataset, a propensity score matching (1:1 without replacement) was performed, which yielded 839 patients for each group (NNS and NS). With a median follow-up time of 3.12 years, median survival for all patients included in the matched dataset was 2.75 years (95% CI: 2.55-2.93 y), with 2- and 5-year OS estimated at 63.9% and 25.7%, respectively. In a multivariable analysis on matched data, there was no difference in mortality risk between the NNS and NS groups (hazard ratio=1.08, 95% CI: 0.94-1.24, P =0.25). Negative prognostic factors identified in the multivariable analysis of the matched data included: age more than 65, male sex, Charlson-Deyo Score ≥1, and tumor size ≥3 cm.
SBRT use in early-stage NSCLC steadily increased over the study period. Most patients proceeded to SBRT without nodal staging, conflicting with National Comprehensive Cancer Network (NCCN) guidelines which recommend pathologic mediastinal lymph node evaluation for all early-stage NSCLC cases, except stage IA. Our findings suggest similar OS in patients with early-stage NSCLC treated with SBRT irrespective of nodal staging. Furthermore, we highlight patient-related, disease-related, and treatment-related prognostic factors to consider when planning therapy for these patients.
立体定向体部放射治疗（SBRT）在早期非小细胞肺癌（NSCLC）中的应用越来越广泛。本研究旨在评估接受 SBRT 治疗的早期 NSCLC 患者的总生存期（OS），并根据分期方法进行分层。
从国家癌症数据库（NCDB）中确定接受根治性 SBRT 治疗的早期 NSCLC 患者，并根据分期方法确定 OS。还分析了患者、疾病和治疗特征。
共纳入 12106 例患者；865 例（7%）接受了侵袭性分期（淋巴结采样，NS），11241 例（93%）未进行淋巴结采样（NNS）。在此更大的数据集基础上，进行了倾向评分匹配（1:1 无替换），每组匹配 839 例（NNS 和 NS）。中位随访时间为 3.12 年，匹配数据集所有患者的中位生存时间为 2.75 年（95%CI：2.55-2.93 年），2 年和 5 年 OS 估计分别为 63.9%和 25.7%。在匹配数据的多变量分析中，NNS 和 NS 组的死亡率无差异（风险比=1.08，95%CI：0.94-1.24，P=0.25）。多变量分析中确定的负性预后因素包括：年龄大于 65 岁、男性、Charlson-Deyo 评分≥1 分和肿瘤大小≥3cm。
研究期间，SBRT 在早期 NSCLC 中的应用稳步增加。大多数患者在没有进行淋巴结分期的情况下接受 SBRT，这与美国国家综合癌症网络（NCCN）指南相冲突，该指南建议对所有早期 NSCLC 病例（IA 期除外）进行病理性纵隔淋巴结评估。我们的研究结果表明，接受 SBRT 治疗的早期 NSCLC 患者的 OS 相似，无论是否进行淋巴结分期。此外，我们强调了在为这些患者制定治疗计划时需要考虑的与患者相关、与疾病相关和与治疗相关的预后因素。
