比较立体定向体部放射治疗和手术治疗临床早期（T1a-b；≤20mm）非小细胞肺癌的长期肺癌特异性生存率和全因生存率的前瞻性队列研究。
Prospective Cohort Study to Compare Long-Term Lung Cancer-Specific and All-Cause Survival of Clinical Early Stage (T1a-b; ≤20 mm) NSCLC Treated by Stereotactic Body Radiation Therapy and Surgery.
作者信息
Henschke Claudia I, Yip Rowena, Sun Qi, Li Pengfei, Kaufman Andrew, Samstein Robert, Connery Cliff, Kohman Leslie, Lee Paul, Tannous Henry, Yankelevitz David F, Taioli Emanuela, Rosenzweig Kenneth, Flores Raja M
机构信息
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Arizona.
Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
J Thorac Oncol. 2024 Mar;19(3):476-490. doi: 10.1016/j.jtho.2023.10.002. Epub 2023 Oct 6.
INTRODUCTION
We aimed to compare outcomes of patients with first primary clinical T1a-bN0M0 NSCLC treated with surgery or stereotactic body radiation therapy (SBRT).
METHODS
We identified patients with first primary clinical T1a-bN0M0 NSCLCs on last pretreatment computed tomography treated by surgery or SBRT in the following two prospective cohorts: International Early Lung Cancer Action Program (I-ELCAP) and Initiative for Early Lung Cancer Research on Treatment (IELCART). Lung cancer-specific survival and all-cause survival after diagnosis were compared using Kaplan-Meier analysis. Propensity score matching was used to balance baseline demographics and comorbidities and analyzed using Cox proportional hazards regression.
RESULTS
Of 1115 patients with NSCLC, 1003 had surgery and 112 had SBRT; 525 in I-ELCAP in 1992 to 2021 and 590 in IELCART in 2016 to 2021. Median follow-up was 57.6 months. Ten-year lung cancer-specific survival was not significantly different: 90% (95% confidence interval: 87%-92%) for surgery versus 88% (95% confidence interval: 77%-99%) for SBRT, p = 0.55. Cox regression revealed no significant difference in lung cancer-specific survival for the combined cohorts (p = 0.48) or separately for I-ELCAP (p = 1.00) and IELCART (p = 1.00). Although 10-year all-cause survival was significantly different (75% versus 45%, p < 0.0001), after propensity score matching, all-cause survival using Cox regression was no longer different for the combined cohorts (p = 0.74) or separately for I-ELCAP (p = 1.00) and IELCART (p = 0.62).
CONCLUSIONS
This first prospectively collected cohort analysis of long-term survival of small, early NSCLCs revealed that lung cancer-specific survival was high for both treatments and not significantly different (p = 0.48) and that all-cause survival after propensity matching was not significantly different (p = 0.74). This supports SBRT as an alternative treatment option for small, early NSCLCs which is especially important with their increasing frequency owing to low-dose computed tomography screening. Furthermore, treatment decisions are influenced by many different factors and should be personalized on the basis of the unique circumstances of each patient.
引言
我们旨在比较接受手术或立体定向体部放射治疗（SBRT）的首发性原发性临床T1a-bN0M0非小细胞肺癌（NSCLC）患者的治疗结果。
方法
我们在以下两个前瞻性队列中，识别出在末次治疗前计算机断层扫描中显示为首发性原发性临床T1a-bN0M0非小细胞肺癌且接受了手术或SBRT治疗的患者：国际早期肺癌行动计划（I-ELCAP）和早期肺癌治疗研究倡议（IELCART）。采用Kaplan-Meier分析比较诊断后的肺癌特异性生存率和全因生存率。使用倾向评分匹配来平衡基线人口统计学和合并症，并采用Cox比例风险回归进行分析。
结果
在1115例非小细胞肺癌患者中，1003例接受了手术，112例接受了SBRT；1992年至2021年I-ELCAP队列中有525例，2016年至2021年IELCART队列中有590例。中位随访时间为57.6个月。10年肺癌特异性生存率无显著差异：手术组为90%（95%置信区间：87%-92%），SBRT组为88%（95%置信区间：77%-99%），p = 0.55。Cox回归显示，联合队列（p = 0.48）、I-ELCAP队列单独分析（p = 1.00）以及IELCART队列单独分析（p = 1.00）的肺癌特异性生存率均无显著差异。尽管10年全因生存率有显著差异（75%对45%，p < 0.0001），但在倾向评分匹配后，联合队列（p = 0.74）、I-ELCAP队列单独分析（p = 1.00）以及IELCART队列单独分析（p = 0.62）使用Cox回归分析的全因生存率不再有差异。
结论
这项首次前瞻性收集的关于小型早期非小细胞肺癌长期生存的队列分析显示，两种治疗方法的肺癌特异性生存率均较高且无显著差异（p = 0.48），倾向匹配后的全因生存率也无显著差异（p = 0.74）。这支持将SBRT作为小型早期非小细胞肺癌的一种替代治疗选择，鉴于低剂量计算机断层扫描筛查导致其发病率不断增加，这一点尤为重要。此外，治疗决策受多种不同因素影响，应根据每位患者的独特情况进行个性化制定。
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